Pancreatitis Flashcards
What type up organ is the pancreas?
Retroperitoneal
What are the anatomical relations of the pancreas?
Tail of pancreas close to the spleen Head enveloped by duodenum Bile duct running through head of pancreas before duodenum Stomach anterior to it Transverse colon inferior to it
Pancreatic ducts empty where
Into duodenum at ampulla of Vater at same place of bile duct
Exocrine function of the pancreas
- proteases
- lipases
- amylase
- phospholipases
Cells in pancreas?
Acinar cells
Ductal cells
Islets of Langerhans
Role of acinar Cells
Produce proteases, lipases, amylase, phospholipases
Role of ductal cells
Produce pancreatic Juice
Role of islets of langerhans
Endocrine
- contains beta cells producing insulin and alpha cells producing glucagon
Endocrine function of the pancreas
Produces insulin, glucagon, somatostatin
What is pancreatic juice?
HCO3- = neutralises acid from stomach
2L per day
Brought into duodenum via pancreatic duct along with exocrine enzymes
Causes of acute pancreatitis
Gallstones blocking pancreatic duct Alcohol Hypertriglyceridemia Hypercalcaemia Drugs (steroids, azathioprine, thiazides, anti-retrovirals, valproate) Trauma/hypothermia Iatrogenic (ERCP) Genetic (CFTR) Autoimmune pancreatopathy (IgG4)
Presentation of acute pancreatitis
Abdominal pain central
Radiates to back
High serum amylase and lipase
Multi organ or systemic dysfunction
Scoring systems for pancreatitis severity
Glasgow
Ranson
APACHE II
Management of acute pancreatitis
Aggressive fluid resus - 1-2L bolus - 250-300ml/h - titrate to UO Analgesia - opoid based Empirical ABs - not everyone - if >30% necrotic pancreas, max 14 days Nutrition - enteral feed early - may need to be nasojejunal Complications - sepsis management - cystgastrostomy Later - cholecystectomy - alcohol cessation
Is intensive care needed for acute pancreatitis management?
Some patients - ITU
- SIRS/organ failure
- for mechanical ventilation, hemofiltration, ionotropes
Type 1 autoimmune pancreatitis
- more common
- IgG4 related
- systemic
- lymphocytic infiltrate
- more men, older
- mimick pancreatic cancer
- use HISORt criteria = histology, imaging, serology, other organ involvement, response to steroids
- relapsing remitting
Type 2 autoimmune pericarditis
- single organ
- neutrophilic infiltrate
- younger patients
- IBD association
IgG4 multisystem diseases
Pancreas and bile duct most common (cholangiopathy and pacnreatitis)
- sialoadenitis (Kuttner’s tumour)
- retroperitoneal fibrosis (Ormond’s disease)
- interstitial pneumonitis
- tubulointerstitial nephritis
- Riedel’s thyroiditis
Treatment of IgG4 related disease
Prednisolone (50% relapse)
Azathioprine (remission)
Mycophenolate (alternative)
Rituximab (refractory disease)
Chronic pancreatitis define
Chronic pain syndrome associated with pancreatic atrophy, fibrosis and calcification
Causes of chronic pancreatitis
Alcohol
Multi-hit hypothesis
Genetics
Management of chronic pancreatitis
Analgesia - pain clinic:
- opoids
- neuromodulators
- PD lithiasis (drainage)
- coeliac axis block
Diagnosis of chronic pancreatitis
Imaging - CT/MRI
Endoscopic US - sensitive, specific features
Exocrine insufficiency = weight loss, steatorrhoea, faecal elastase, functional assays
Complications of chronic pancreatitis and management of them
Exocrine insufficiency = pancreatic enzyme supplementation
Endocrine insufficiency = insulin
Obstruction = ERCP, surgical bypass if gastric outlet obstruction
Splenic vein thrombosis = sinestral portal HTN
Pancreatic carcinoma increased risk!
Surgeries for chronic pancreatitis
Improved pancreatic duct drainage
Lateral Pancreaticojejunostomy
Frey’s procedure (pancreatic head)
Total pancreatectomy
