Pancreatitis Flashcards

1
Q

What are the causes of chronic pancreatitis. (7)

A

Alcohol (60-80%).
Rarely: familial, cyctic fibrosis, haemochromatosis, pancreatic duct obstruction (stone/tumour), raised PTH, congenital (pancreas divisum).

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2
Q

What are the symptoms of acute pancreatitis. (8)

A

Epigastric pain ‘bores’ through to the back.
Pain relieved by sitting forward or hot water bottles on epigastrium/back.
Bloating.
Steatorrhoea.
Weight loss.
Brittle diabetes.
Jaundice due to obstruction of CBD (rarely).
Symptoms relapse and worsen.

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3
Q

What is erytheme ab igne’s.

A

Mottled dusky greyness of the skin following chronic application of hot water bottles.

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4
Q

How is chronic pancreatitis diagnosed.

A

Ultrasound and CT.

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5
Q

What confirms a diagnosis of chronic pancreatitis.

A

Pancreatic calcifications seen on ultrasound/CT.

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6
Q

What are the complications of chronic pancreatitis. (7)

A
Pseudocyst. 
Diabetes. 
Biliary obstruction. 
Local arterial aneurysm. 
Splenic vein thrombosis. 
Gastric varices. 
Pancreatic carcinoma.
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7
Q

What is chronic pancreatitis.

A

Continuous inflammation with irreversible structural changes to the pancreas.

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8
Q

What is seen on the blood results of a patient with chronic pancreatitis. (3)

A

Raised serum amylase.
Raised serum lipase.
Abnormal faecal elastase.

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9
Q

What is the differential diagnosis for patients presenting with chronic pancreatitis. (2)

A

Pancreatic carcinoma.

Chronic pancreatitis.

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10
Q

What are the complications of chronic pancreatitis. (4)

A

Pancreatic pseudocyst is the most common complication (a fluid collection surrounded by granulation tissue).
Ascites.
Pleural effusions.
Increased risk of malignancy.

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11
Q

What is involved in acute pancreatitis.

A

Self-perpetuating pancreatic inflammation by enzyme-mediated autodigestion.

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12
Q

What are the causes of acute pancreatitis. (13)

A
Gallstones. 
Ethanol. 
Trauma. 
Steroids. 
Mumps. 
Autoimmune. 
Scorpion venom. 
Hyperlipidaemia, hypothermia, hypercalcaemia. 
ECRP and emboli. 
Drugs. 

Also: pregnancy, neoplasia and no cause found.

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13
Q

What are the symptoms of acute pancreatitis. (4)

A

Gradual or sudden severe epigastric or central abdominal pain.
Pain radiates to the back.
Pain may be relieved by sitting forward.
Vomiting is prominent.

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14
Q

What are the physical signs of acute pancreatitis. (9)

A
May be mild or serious. 
Tachycardia. 
Fever. 
Jaundice. 
Shock. 
Ileus. 
Rigid abdomen. 
Local or generalised tenderness. 
Periumbilical bruising (Cullen's sign). 
Flank bruising (Grey Turner's sign).
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15
Q

What is the cause of Cullen’s and Grey Turner’s signs in acute pancreatitis.

A

From blood vessel autodigestion and retroperitoneal haemorrhage.

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16
Q

What is seen on the blood test of a patient with acute pancreatitis. (3)

A

Raised serum amylase.
Raised serum lipase.
Raised CRP.

17
Q

What conditions can cause a raised serum amylase. (5)

A
Pancreatitis. 
Cholecystitis. 
Mesenteric infarction. 
GI perforation. 
Renal failure.
18
Q

What tests should be conducted in a patient with acute pancreatitis. (6)

A
Blood tests. 
CXR. 
ABG. 
AXR. 
US. 
CT/MRI.
19
Q

Why is a CXR conducted in a patient with acute pancreatitis.

A

To exclude other causes (eg perforation).

20
Q

What is seen on the AXR of a patient with acute pancreatitis.

A

No psoas shadow (as there is an increase in the retroperitoneal fluid level).

21
Q

What are the early complications of acute pancreatitis. (7)

A
Shock. 
ARDS. 
Renal failure. 
DIC. 
Sepsis. 
Low calcium.
High glucose.
22
Q

What are the late complications of acute pancreatitis. (7)

A
Pancreatic necrosis. 
Pseudocysts. 
Abscess. 
Bleeding. 
Thrombosis. 
Fistulae. 
Recurrent oedematous pancreatitis.
23
Q

What percentage of acute pancreatitis cases are mild.

A

80%.

24
Q

What percentage of acute pancreatitis cases develop severe/life-threatening complications.

A

20%.

25
Q

What is acute pancreatitis.

A

It is a syndrome of inflammation of the pancreatic gland initiated by an acute injury.

26
Q

What factors indicate a poor prognosis in acute pancreatitis. (9)

A
Age >55. 
WCC >15. 
Glucose >10. 
Urea >16. 
Albumin 200. 
Calcium 600. 
PaO2