Pancreatitis Flashcards

1
Q

Pathophysiology of acute pancreatitis?

A

autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

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2
Q

List 4 causes of pancreatitis

A
  1. Gallstones
  2. Alcohol
  3. Post-ERCP
  4. Trauma
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3
Q

List 2 drugs associated with pancreatitis

A
  1. Furosemide
  2. Azathioprine
  3. Thiazide
  4. Mesalazine
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4
Q

Pathophysiology of “Gallstone pancreatitis”

A
  1. Stones get trapped at the ampulla of vater
  2. Reflux of bile into the pancreatic duct and the no outflow of pancreatic juice into duodenum
  3. Results in inflammation in the pancreas
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5
Q

Pathophysiology of “alcoholic pancreatitis”

A

Alcohol is directly toxic to pancreatic cells, resulting in inflammation

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6
Q

List 4 features of acute pancreatitis

A
  1. Severe epigastric pain radiating to the back
  2. Vomiting
  3. Abdominal tenderness
  4. Systemically unwell (eg. low-grade fever and tachycardia).
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7
Q

List 2 signs on examination of pancreatitis

A

Cullen’s sign - Periumbilical discolouration

Grey Turner’s sign - Flank discolouration

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8
Q

List 4 blood Investigations for acute pancreatitis

A
  1. FBC
  2. U&E
  3. Serum amylase
  4. Serum lipase
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9
Q

List 3 imaging investigations for acute pancreatitis

A
  1. USS abdomen - to look for gallstones
  2. MRCP - to look for obstructive pancreatitis (ERCP is often preferred)
  3. CT scan for complications (ie. pseudocysts or necrotising pancreatitis)
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10
Q

What scoring system can be used to assess the severity of pancreatitis?

A

The modified Glasgow criteria:

  • 0 or 1 – mild pancreatitis
  • 2 – moderate pancreatitis
  • 3 or more – severe pancreatitis
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11
Q

Management of acute pancreatitis

A
  1. ABCDE, IV fluids, Analgesia
  2. Careful monitoring
  3. Treatment of stones in gallstone pancreatitis
  4. Antibiotics ONLY if infection (abscess or infected necrotic area)
  5. Treat complications
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12
Q

Treatment for gallstone pancreatitis?

A

ERCP or cholecystectomy

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13
Q

Treatment for an obstructed biliary system?

A

ERCP

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14
Q

List 4 complications of acute pancreatitis

A
  1. Necrosis of the pancreas
  2. Infected area of necrosis
  3. Abscess formation
  4. Pseudocysts can develop ~ 4 weeks later
  5. Chronic pancreatitis
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15
Q

What is a Pseudocyst?

A

fluid-filled sac of pancreatic enzymes, blood and necrotic tissue which forms in the abdomen

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16
Q

What is chronic pancreatitis?

A

Chronic inflammation and fibrosis of both the exocrine and endocrine components of the pancreas

17
Q

List 4 causes of chronic pancreatitis

A
  1. Alcohol
  2. Cystic fibrosis
  3. Pancreatic cancer
  4. Haemochromatosis
18
Q

List 3 features of chronic pancreatitis

A
  1. Epigastric pain - worse after eating fatty food and relieved by sitting forward
  2. Malabsorption and steatorrhoea
  3. T1DM with thirst and polyuria
19
Q

Investigations for chronic pancreatitis

A
  1. Abdominal x-ray - calcifications
  2. CT scan - calcifications (more sensitive)
  3. Faecal elastase (exocrine function)
  4. Fasting glucose/OGTT test (endocrine function)
20
Q

What investigation may help differentiate acute vs chronic pancreatitis?

A

Serum amylase and lipase are not typically raised in chronic pancreatitis

21
Q

Management of chronic pancreatitis

A
  1. Abstinence from alcohol and smoking
  2. Analgesia
  3. Pancreatic enzymes (Creon)
  4. Insulin for diabetes
  5. ERCP stenting for strictures and obstruction
  6. Surgery for severe complications
22
Q

List 2 complications of chronic pancreatitis

A
  1. Pseudocyst
  2. Pancreatic cancer
  3. DM
  4. Malabsorption and steatorrhoea