Pancreatitis Flashcards

1
Q

Where is the pancreas located?

A

Behind the stomach, next to the small intestine

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2
Q

What is the endocrine function of the pancreas?

A
  • Insulin
  • Glucagon
  • Somatostatin
  • Pancreatic polypeptide
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3
Q

What is the exocrine function of the pancreas?

A
  • Amylase
  • Proteases
  • Lipases
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4
Q

What are the symptomatic consequences of an unwell pancreas?

A
  • Diarrhoea
  • Bloating
  • Flatulence
  • Oily and foul smelling stools
  • Weight loss
  • Malnutrition
  • Poor blood sugar control
  • Diabetes
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5
Q

What is acute pancreatitis?

A

Sudden inflammation of the pancreas

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6
Q

What are the causes of acute pancreatitis?

A

GET SMASHED

G - Gallstones
E - Ethanol
T - Trauma

S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion venom
H - Hypertriglyceridaemia, Hyperchylomicronaemia
E - ERCP
D - Drugs 
      (azathioprine, mesealazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

Genetic - Cystic fibrosis and hereditary pancreatitis

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7
Q

What are the symptoms of pancreatitis?

A
  • Sudden attacks
  • Epigastric pain
  • Radiates to the back
  • Pain relieved by sitting forward / hot water bottles
  • Nausea and vomiting
  • Fever
  • Tachycardia
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8
Q

What blood tests would you order and what would they show?

A

Amylase and lipase

- Elevated

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9
Q

What investigations would you order and what would they show?

A
- CT/MRI
      Swollen pancreas
      Abnormal fluid around pancreas
- ERCP
      If duct blockage suspected
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10
Q

What is the treatment for acute pancreatitis?

A
  • Nil by mouth
  • Fluid resuscitation
    Crystalloid
    Monitor urine ouptu
  • Analgesia
  • Supplemental O2
  • Consider antiemetic
  • Surgery if gallstones are the cause
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11
Q

What is the advice you would give to a patient with acute pancreatitis?

A

Avoid:

  • Alcohol and tobacco
  • High-fat foods
  • Triglycerides
  • Specific medication
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12
Q

How can you identify severe pancreatitis?

A

PANCREAS

P - PaO2 - <8kPa
A - Age - >55yrs
N - Neutrophillia – WBC >15 x 109/L
C - Calcium - <2mmol/L
R - Renal function- Urea >16 mmol/L
E - Enzymes – LDH>600iu/L; AST>200iu/L
A - Albumin - <32g/L (serum)
S - Sugar – Blood glucose >10mmol/L
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13
Q

What is chronic pancreatitis?

A

Long-term inflammation of the pancreas which leads to irreversible damage of the pancreas

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14
Q

What are the symptoms of late chronic pancreatitis?

A
  • Oily, foul smelling stools
  • Weight loss
  • Diabetes
  • Recurring pain
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15
Q

What diagnostic test would you order for chronic pancreatitis?

A
  • Blood glucose
  • Abdo XR
    Calcification
  • US +/- CT
    Calcification
  • Endoscopic ultrasound
  • Faecal elastase
    Decreased
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16
Q

What is the treatment for chronic pancreatitis?

A
  • No alcohol
  • Smoking cessation
  • Avoid high-fat foods
  • Analgesia
  • PERT (pancreatic enzyme replacement therapy)
  • PPI
    Omeprazole
  • Multivitamins and mineral supplements
17
Q

What are the complications of chronic pancreatitis?

A

Type 3c diabetes

- Destruction of islet cells

18
Q

What may you find on examination of a patient with acute pancreatitis?

A
  • Tenderness, ileus and low-grade fever
  • Cullen’s sign
    Periumbilical discolouration
  • Grey-Turner’s sign
    Flank discolouration
19
Q

What are the complications of acute pancreatitis?

A
  • Peripancreatic fluid collections
  • Pseudocysts
  • Pancreatic necrosis
  • Pancreatic abscess
  • Haemorrhage