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Gastrointestinal > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What does the pancreas do?

A

Endocrine: production of hormones involved in regulation of sugar in the body and metabolism

Exocrine: secretion of enzymes involved in digestion

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2
Q

What does the endocrine portion of the pancreas produce?

A

Insulin: lowers blood sugar
Glucagon: raises blood sugar

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3
Q

What does the exocrine portion of the pancreas produce?

A

Digestive enzymes: amylase, lipase, proteases

These help digestion in the small intestine

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4
Q

What is the difference between acute and chronic pancreatitis?

A

Acute: when a normal pancreas becomes damaged but it returns to its normal self afterwards.
Isolated or recurrent attacks

Chronic: continuing inflammation with irreversible structural changes

Sometimes there is overlap!

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5
Q

What causes acute pancreatitis?

A

GET SMASHED

Gall stones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion stings
Hyperlipidaemia
ERCP
Drugs
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6
Q

What is ERCP?

A

Endoscopic retrograde cholangiopancreatography

A procedure where a camera is fed into the pancreatic ducts via the duodenum

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7
Q

What’s the general pathogenesis of acute pancreatitis?

A

The causes (GET SMASHED) all cause a rise in intracellular calcium levels

This leads to excessive release of pancreatic enzymes

These damage the acinar cells, necrosis occurs

Inflammatory cells migrate to the area,

They release pro-inflammatory cytokines leading to an immune response

Can become systemic leading to multiple organ failure

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8
Q

Clinical features of acute pancreatitis?

A

Epigastric or upper abdominal pain radiating to back
Nausea + vomiting

Epigastric or general abdominal tenderness, guarding and rigidity

Pyrexia
Tachycardia
Jaundice
Septic shock

Grey Turner’s sign or Cullen’s sign

Can initially present with coma, multi-organ failure

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9
Q

What is Grey Turner’s sign?

A

Left flank ecchymosis (bruising)

Area between ribs and hips

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10
Q

What is Cullen’s sign?

A

Periumbilical ecchymosis

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11
Q

What is ecchymosis?

A

Discoloration of skin due to bleeding underneath

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12
Q

What 3 classes of acute pancreatitis are there?

A

Oedematous: associated with phlegmon formation

Severe/necrotising: associated with pseudocyst formation

Haemorrhagic: bleeding

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13
Q

What is phlegmon?

A

Diffuse inflammatory process where pus abscesses are formed

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14
Q

What is a pseudocyst?

A

Persistent pancreatic fluid collection which can become infected

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15
Q

Investigations for acute pancreatitis?

A

Bloods:

  • raised serum amylase or lipase
  • raised CRP
  • U+E, FBC, ABG to measure severity

Radiology

  • X-ray
  • USS: look for gallstones
  • Contrast CT + MRI
  • ERCP
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16
Q

What can you see on a CT of a patient with acute pancreatitis?

A

Loss of fat planes
Pancreatic oedema
Swelling
Fluid build up

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17
Q

What is the Glasgow Scoring System of acute pancreatitis used for?

A

PANCREAS

It determines the severity of the pancreatitis

A score of more than 3 = ITU admission

18
Q

What is the Glasgow Scoring System?

A

Measures severity of acute pancreatitis:

PANCREAS

PaO2 less than 8kPa
Aged above 55
Neutrophils raised
Calcium low
Raised urea
Elevated enzymes (LDH test)
Albumin low
Sugar high
19
Q

What is the LDH blood test?

A

Lactate dehydrogenase levels in the blood

High levels = severe tissue damage

20
Q

What are some other scoring systems for acute pancreatitis?

A

Ranson Criteria: measures severity and risk or mortality

Balthazar score: looks at CT scan

Necrosis score: % of necrosis of pancreas

21
Q

Management of acute pancreatitis?

A

Assessment of severity

ABCDE resuscitation

Analgesia

Bowel rest: nil by mouth

Drainage of fluid build-up

Antibiotics: chosen from result of fluid drainage

Nutrition: IV, Nasogastric

Admit to ITU if risk of organ failrue

22
Q

What are 2 complications of acute pancreatitis?

A

SIRS - Systemic Inflammatory Response Syndrome

MODS - Multiple Organ Dysfunction Syndrome

23
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome

A state of inflammation in the body where there is no documented infection

Tachypnoea
Tachycardia
Pryexia
Raised WBC

24
Q

What is MODS?

A

Multiple Organ Dysfunction Syndrome

A complication of SIRS leading to loss of homeostasis mechanisms in the body

25
Q

SIRS is a complication of MODS.

True or false?

A

False

MODS occurs as a complication of SIRS

26
Q

What are the 2 key causes of acute pancreatitis?

A

Gall stones

Alcohol

27
Q

How do gall stones cause acute pancreatitis?

A

They block the bile duct

Blocking pancreatic enzymes from getting to duodenum

Enzymes are forced back to the pancreas

Where they irritate the pancreas

Leading to pancreatitis

28
Q

What is the general pathophysiology of chronic pancreatitis?

A

Mechanism is pretty unclear

Thought to be due to obstruction/reduction of bicarbonate excretion

Which leads to the activation of pancreatic enzymes

Also, protein precipitation in pancreas blocks ducts, leading to ductal hypertension

This causes damage

Both these lead to inflammation, necrosis and fibrosis of pancreatic tissue

29
Q

What are the causes of chronic pancreatitis?

A

Alcohol

Familial
Autoimmune
Cystic fibrosis
Pancreatic duct obstruction
Haemochromatosis
30
Q

What is haemochromatosis?

A

The build of iron in the body

It is deposited in organs, especially the liver and skin

31
Q

How does alcohol cause chronic pancreatitis?

A

Alcohol causes proteins to precipitate (become solid) in the ducts of the pancreas

This leads to local pancreatic dilation and fibrosis

Also, alcohol has direct toxic effect on pancreas

This results in pancreatic fibrosis and calcification

32
Q

Only heavy drinkers get chronic pancreatitis.

True or false?

A

False

Even people who drink alcohol reasonably are at risk

33
Q

Why does the pancreas become fibrotic in chronic pancreatitis?

A

Because of long term inflammation that results in irreversible damage

34
Q

Is the damage reversible in:

  • acute pancreatitis
  • chronic pancreatitis?
A 
Acute = yes
Chronic = no
35
Q

Is chronic pancreatitis progressive or does it go in phases?

A

Both

Patients relapse and get worse
But relapses are intermittent

36
Q

What are the clinical features of chronic pancreatitis?

A

Epigastric pain that bores through to the back

Weight loss + anorexia

Nausea and vomiting

Diabetes develops due to lack of insulin production

Steatorrhoea develops due to lack of lipase production

Malabsorption due to lack of digestive enzymes

37
Q

What can help relieve the epigastric pain experience in pancreatitis?

A

Leaning forward

Heat

38
Q

What should you rule out before diagnosing chronic pancreatitis?

A

Pancreatic carcinoma

39
Q

Investigations of chronic pancreatitis?

A

USS + CT: shows up calcification and fibrosis

ERCP: check out state of pancreas

AXR: pancreas appears speckled due to calcification

Bloods:

  • raised ESR + CRP
  • autoantibodies in autoimmune pancreatitis
  • raised blood glucose
40
Q

What blood results would you see in autoimmune chronic pancreatitis?

A

Elevated levels of serum gammaglobulins and immunoglobulins

Auto-antibodies

41
Q

Treatment of chronic pancreatitis?

A

Analgesia

Give lipase + fat soluble vitamins

Give insulin to treat diabetes

Autoimmune pancreatitis responds well to steroids

Modify diet: low fat, no alcohol

Surgery if necessary: pancreatectomy

Gastrointestinal (20 decks)

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