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pancreatitis Flashcards

1
Q

divided into

A

acute and chronic

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2
Q

can acute return to normal

A

yes

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3
Q

what is seen in chronic pancreatitis

A

continuing inflammation with irreversible structural damage

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4
Q

is chronic pancreatitis reversible

A

no

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5
Q

what is acute pancreatitis

A

inflammation of the pancreatic gland initiated by any acute injury

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6
Q

what are most common causes of acute

A
  • gallstones

- alcohol

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7
Q

causes of acute

A

I GET SMASHED

  • idiopathic
  • gallstone
  • ethanol (alcohol)
  • trauma
  • steroids
  • mumps
  • autoimmune
  • scorpion sting
  • hypercalcaemia
  • ERCP
  • drugs
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8
Q

how can gallstone cause pancreatitis

A

by obstructing to pancreatic drainage at the ampulla by a stone

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9
Q

what happens pathologically in gallstone pancreatitis

A
  1. trypsinogen is cleaved to trypsin
  2. trypsin is degraded by chmotryspin C is impaired
  3. intracellular calcium increases
  4. increased calcium causes more trypsinogen
  5. acinar cell damage
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10
Q

what does alcohol interfere with in pancreatitis

A

calcium homeostasis in pancreatic acinar cells

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11
Q

what does alcohol activate in pancreas

A

pancreatic stellate cells by acetylaldehyde

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12
Q

what do pancreatic stellate cells produce

A

collagen and matrix proteins

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13
Q

where is the pain in acute

A

upper abdominal

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14
Q

symptoms of acute

A
  • epigastric pain
  • nausea
  • vomiting
  • pain spreads to back
  • previous gallstones
  • alcoholic binge
  • tachycardia
  • hypotension
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15
Q

signs of acute

A
  • absent bowel sounds
  • Cullens sign
  • Grey Turners (bruising)
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16
Q

what investigations are done for acute

A
  • serum amylase
  • urinary amylase
  • serum lipase
  • CRP level
  • CXR
  • ultrasound
  • CT
  • MRCP
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17
Q

is serum amylase a sensitive test

A

yes

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18
Q

what are other causes of elevated serum amylase

A
  • upper GI perforation

- peritonitis

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19
Q

is urinary amylase diagnostic

A

yes

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20
Q

are serum amylase levels elevated for a long time

A

no

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21
Q

what is CRP level useful for

A

severity and prognosis

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22
Q

what is a mandatory investigation

A

CXR

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23
Q

why is a CXR done

A

to exclude gastroduodenal perforation - this also raises serum amylase

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24
Q

what is ultrasound used for

A

to identify a possible gallstone

25
Q

what is ERCP used for

A

treatment measure to remove bile duct stones

26
Q

what is required early for treatment for acute

A
  • IV fluids
  • urinary catheter
    to monitor circulating volume and renal function
27
Q

what does nasogastric suction do

A

prevents abdominal distension and vomitus

= reduces risk of aspiration pneumonia

28
Q

treatment methods of acute

A
  • antibiotics
  • analgesia
  • feeding
  • anticoagulation
29
Q

why is anticoagulation given

A

LMWH heparin is given for prophylaxis of DVT

30
Q

what is treatment of gallstone pancreatitis

A

endoscopic intervention with sphincterotomy and stone extraction

31
Q

how else can stones be removed

A

by ERCP

32
Q

complications of acute pancreatitis

A
  • SIRS
  • necrosis
  • abscess
  • pleural effusion
  • pneumonia
  • GI bleed
  • hypoglycaemia
33
Q

what is the cause of chronic

A

alcohol

34
Q

pathology of chronic

A

an increase in activated trypsin within the pancreas

35
Q

what cells produce chymotrypsin C

A

acinar cells

36
Q

what does chymotrypsin C do

A

inactivate trypsin

37
Q

where is CFTR

A

apical surface of the acinar cells

38
Q

how many types of autoimmune chronic pancreatitis

A

2

39
Q

who is most likely to get type 1 ACP

A

middle aged men

40
Q

what causes type 1 ACP

A

IgG 4 lecels

41
Q

can type 1 ACP spread

A

yes

42
Q

can type 2 ACP spread

A

no

43
Q

symptoms of chronic

A
  • epigastric pain
  • pain radiates to back
  • anorexia
  • weight loss
  • malabsorption
  • diabetes can occur
  • steatorrhoea
44
Q

what can exacerbate pain in chronic

A

alcohol

45
Q

investigations for chronic

A
  • serum amylase and lipase
  • serum IgG4 levels
  • faecal elastase
  • gene mutation
  • ultrasound
  • CT
  • MRI with MRCP
46
Q

what are serum amylase and lipase levels

A

elevated

47
Q

what is ultrasound useful for

A

initial analysis

48
Q

what does CT enhance

A

more detail

  • presence of pancreatic calcification
  • dilated pancreatic duct
49
Q

what has MRCP replaced

A

ERCP

50
Q

differential diagnosis of chronic

A

pancreatic malignancy

51
Q

treatment for abdominal pain in chronic

A
  • NSAIDs
  • opiate
  • ## tricyclic antidepressants
52
Q

can patients become pain free

A

yes after 6-10 years

53
Q

why does patient get steatorrhoea

A

due to malabsorption

54
Q

how to treat malabsorption in chronic

A

pancreatic enzyme supplements

55
Q

is associated diabetes easy to control

A

no

56
Q

treatment for autoimmune pancreatitis

A

glucocorticoid therapy e.g. prednisolone

57
Q

complications of chronic

A
  • pancreatic pseudocyst
  • ascites
  • pleural effusions
  • pancreatic cancer
58
Q

what is pancreatic pseudocyst

A

fluid collection surrounded by granulation tissue

59
Q

dangers of larger cysts

A

may occlude nearby structures including duodenum

GI (50 decks)

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