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GI: liver, biliary tree and pancreas > pancreatitis > Flashcards

pancreatitis Flashcards

1
Q

what is the classical acute pancreatitis

A

They get sudden onset severe abdominal pain and patients may be seriously shocked

Elevated serum amylase

pain may go to the back

indigestion

temperature a

jaundice

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2
Q

Pathogenesis of acute pancreatitis

  1. Bile reflux, duct ____ due to ___ damage to the sphincter of Oddi all cause pancreatic duct ______ injury
    - The loss of _____ barrier allows the _______ of pancreatic acini
  2. Release of lytic pancreatic enzymes - ____ and ____
A
  1. Bile reflux, duct obstruction due to stone damage to the sphincter of Oddi all cause pancreatic duct epithelial injury
    - The loss of protective barrier allows the autodigestion of pancreatic acini
  2. Release of lytic pancreatic enzymes - proteases and lipases
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3
Q

______- cause tissue destruction and haemorrhage

A

Proteases - cause tissue destruction and haemorrhage

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4
Q

_____ - intra-and peripancreatic fat necrosis.

This atttracts _____

A

Lipases - intra-and peripancreatic fat necrosis

This attracts calcium

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5
Q

______ is an almost immediate consequence of acute of Release of lytic pancreatic enzymes - proteases and lipases

A

haemorhage

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6
Q

what are the systemic complications of acute?

A 
pulmonary failure 
renal failure (HIGHLY LIKELY)
sepsis
metabolic acidosis 
Death 
Shock 
Hypocalcaemia 
Hyperglycaemia
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7
Q

what is chronic pancreatitis

A

Relapsing disorder may develop insidiously or following bouts of acute pancreatitis

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8
Q

what are the causes of chronic pancreatitis?

A 
Alcohol
Cholelithiasis
Cystic fibrosis
Hyperparathyroidism
Familial
viral infection
hypothermia 
trauma
drugs
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9
Q

what is the pathology of chronic?

A

Get the replacement of pancreas by chronic inflammation and scar tissue

Destruction of exocrine acini and islets (islets tend to last longer)

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10
Q

in chronic The inflammation and firbosis mimicks a ____ in the head of the pancreas

A

tumour

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11
Q

in acute P what is the management If they are a surgical candidate:

A

Cholecystectomy

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12
Q

in acute P what is the management If they are a non surgical candidate:

A
  • ERCP/ES if frail

They will have a sphincterotomy too to prevent blockage of stones as this will allow them to pass straight through to the duodenum

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13
Q

minimal organ dysfunction and uneventful recovery. Predominant feature is interstitial oedema of the gland

A

mild acute pancreatitis

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14
Q

what is the pancreatitis associated with organ failure and /or local complication such as necrosis, pseudocysts or abscess

A

severe acute pancreatitis

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15
Q

mumps, coxsackie B and viral hepatitis

A

what viruses can cause acute pancreatitis

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16
Q

how is a diagnosis of ACUTE pancreatitis made?

A

history ,

examination (tenderness, peritonism, distension, bowel sounds and skin markings)

and blood tests

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17
Q

what blood tests are usually done?

A

FBC, Clotting, U & E’s, LFT’s, Amylase, CRP, Glucose, Ca

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18
Q

what is the FBC like in acute pancreatitis ?

A

leukocytosis

19
Q

what do the lipase and amylase show in acute pancreatitis?

A

both raised but amylase raised by 3x ULN

20
Q

what does haematocrit tell you

A

it is a predictor of pancreatic necrosis

21
Q

what is ABG like for acute pancreatitis

A

hypoxaemia and disturbances in acid base balance

22
Q

what imaging may be done in acute pancreatitis

A

CXR/AXR, AUS, CT Pancreas, MRI, ERCP- these are not diagnostic but can be useful

23
Q

what is the first imaging tool you ask for and why? for acute pancreatitis

A

US to rule out biliary pancreatitis

24
Q

what may be seen on CXR/AXR of acute pancreatitis?

A

sentinel loop or pleural effusion

25
Q

what is a sentinel loop

A

localised ileus from nearby inflammation

26
Q

what are the local complications of acute pancreatitis

A 
fluid collections
pancreatic necrosis 
ascites
bleeding 
abscess 
pseudocyst formation
27
Q

what are pseudocysts

A

collections of fluid with high enzyme concentrations

28
Q

complication of AP and CP which can cause biliary obstruction and gastric outlet obstruction

the patient has pain, nausea, vomiting, jaundice, weight loss

A

pseudocyst

29
Q

what is the treatment for a pseudocyst

A

endoscopic drainage or surgical drainage

30
Q

This is basically an infected cyst

A

pancreatic abscess

31
Q

what is the treatment of pancreatic abscess

A

Drain abscess, control sepsis

Via CT/US guided retroperitoneal or transperitoneal drainage

32
Q

what is CT used for in pancreatitis

A

to assess severity of necrosis

33
Q

this is a progressive and irreversible destruction of the pancreatic tissue which results in the loss of endocrine and exocrine function

A

chronic pancreatitis

34
Q

what are the causes of CP?

A 
alcohol - 60-80% 
pancreatic duct obstruction
autoimmune 
tropical pancreatitis
hereditary 
hypercalcaemia in hyperparathyroidism
35
Q

what is the rare but important hereditary cause of CP

A

CF

36
Q

what are some acquired causes of pancreatic duct obstruction

A

cholelithiasis, stricture, tumour pseudocyst

37
Q

what is a congenital cause of pancreatic duct obstruction

A

pancreas divisum

38
Q

what are the first tests to order in CP

A

blood tests
CT
US
AXR

39
Q

what may AXR and CT show for CP

A

calcifications

40
Q

what may need to be supplemented in CP

A

insulin, lipase,fat soluble vitamins

41
Q

what surgery can be done for unremitting pain or weight loss in CP

A

Pustow procedure for dilated pancreatic duct - pancreeatic duct is anastomosed to jejunum

42
Q

what are the complications of chronic CP?

A

splenic vein thrombosis

  • risk of pancreatic cancer
  • pseudocyst
  • pseudoaneurysms
  • bile duct or duodenal obstruction
  • pancreatic ascites
  • pleural effusion
  • diabetes
43
Q

what is a pseudoaneurysm?

A

erosion of a pseudocyst into an artery

44
Q

what is the treatment for biliary or duodenal obstriction

A

stent, bypass or resection

GI: liver, biliary tree and pancreas (20 decks)

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