Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Met3a > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Is the pancreas intraperitoneal or retroperitoneal

A
  • Retroperitoneal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the function of the pancreas

A

Exocrine - Acinar cells

  • proteases - chymotrypsin, trypsin, pepsin
  • lipases
  • amylases
  • phopsholipases

Pancreatic juice
- bicarbonate risk, 2L per day - produced by the ductal cell

Endocrine - Islets of Langerhan

  • beta cells - insulin
  • alpha cells - glucagon
  • other hormones - somatostatin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe how the enzymes produced by the exocrine function become activated

A
  • enzyme is created in an inactive form
  • goes into the duct
  • enzymes become activated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Premature activation of enzymes within ..

A

premature activation of enzymes within pancreatic parenchyma leading to pancreatic auto-digestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cause of acute pancreatitis

A

GET SMASHED

  • Gallstones (~35%)
  • Ethanol (35%)
  • Trauma (1.5%)
  • Steroids
  • Mumps
  • Autoimmune (PAN)
  • Scorpion venom
  • Hyperlipidaemia, Hypothermia, Hypercalcaemia
  • ERCP (~5%)
  • Drugs
    Other: pregnancy, neoplasia, no cause found (~10-30%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of acute pancreatitis

A
  • Gradual or sudden severe epigastric or central abdominal pain (radiates to back, relieved by sitting forward
  • vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the clinical presentation of a severe acute pancreatitis

A
  • mortality is less than 1% mild AP; 10-25% severe AP
  • Oedematous vs necrotising pancreatitis (5-10%)
  • CRP is greater than 150mg/L at 48 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the scoring systems for acute pancreatitis

A
  • Glasgow
  • Alanta
  • Ranson
  • APACHE II
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you manage acute pancreatitis

A

Aggressive fluid resuscitation

  • 1-2L bolus
  • 250-300ml/h
  • titrate to urine output and other parameters

Analgesia
- opioid based

empirical antibiotics

  • consider if greater than 30% pancreatic necrosis, max 14 days
  • but no proven role

Nutrition

  • early enteral feeding preferable
  • may need to be nasojejunal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the types of autoimmune pancreatitis

A
  • Type 1

- Type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe type 1 pancreatitis

A

IgG4 related disease

  • systemic disease
  • lymphocytic infiltrate
  • more common in men, 40-60s
  • mimic of pancreatic cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What score is used to assess type 1 autoimmune pancreatitis

A

HISORt criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe how the HISORTr score works

A 
H - histology 
I - imaging 
S - serology 
O - other organ involvement 
Rt - response to steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe type 2 autoimmune pancreatitis

A

Single organ

  • neutrophilic infiltration
  • younger patients
  • IBD association
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What systems can IgG4 affect

A
  • pancreatitis
  • cholangiopathy
  • sialoadenitits
  • retroperitoneal fibrosis
  • interstitial pneumonitis
  • tubulointerstitial nephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment of IgG4 related disease (type 1 autoimmune pancreatitis)

A
  • Prednisolone (50%) relapse
  • azathioprine - remission
  • mycophenolate - alternative
  • Rituximab - refractory disease - steroid refractory disease and induction of remission
17
Q

What is chronic pancreatitis associated with

A
  • pancreatic atrophy
  • fibrosis
  • calcification
18
Q

What can cause chronic pancreatitis

A
  • Alcohol
  • smoking
  • autoimmune
  • cystic fibrosis
  • pancreatic duct obstruction
  • congenital
  • haemochromatotsis
19
Q

How do you manage chronic pancreatitis

A

analgesia

  • opioids
  • neuromodulators
  • improve PD drainage
  • coeliac axis block

fat soluble vitamins

insulin

diet

  • no alcohol
  • low fat may help
20
Q

How do you diagnose chronic pancreatitis

A

Imaging
- CT/MRI features

EUS

  • more sensitive
  • specific features

Exocrine insufficiency

  • steatorrhoea, weight loss
  • faecal elastase
  • functional assays - pancreolauryl test
21
Q

What are the complications of chronic pancreatitis

A

Exocrine insufficiency
- pancreatic enzyme supplementation

Endocrine insufficiency
- insulin

Obstruction

  • CBD - ERCP covered metal stent
  • Gastric outlet obstruction - surgical bypass

Splenic vein thrombosis - sinestral portal hypertension

Pancreatic carcinoma
- 2-10x increase risk

  • pseudocyst
  • diabetes
  • biliary obstruction
  • local material aneurysm
  • gastric varices
22
Q

how is ERCP used in chronic pancreatitis

A
  • PD stricture with upstream dilatation
  • PD lithiasis
  • control pancreatic pain
23
Q

What surgeries can you use for chronic pancreatitis

A
  • Lateral pancreaticojejunostomy - puestow
  • freys procedure - pancreatic head
  • total pancreatectomy
  • aim to improve PD drainage by opening up the pancreatic duct
24
Q

What are the signs of acute pancreatitis

A
  • raised heart rate
  • fever
  • jaundice
  • shock
  • ileus
  • rigid abdomen +/- local tenderness
  • periumbilical bruising (Cullen’s sign)
  • Flanks Bruising (Grey Turner’s sign)
25
Q

What investigations do you use to measure acute pancreatitis

A
  • Amylase will increase - >1000U/mL or around 3-fold upper limit of normal
  • lipase raised - more sensitive and specific for pancreatitis and rises earlier and falls later
  • ABG - to monitor oxygenation and acid-base status
  • AXR
  • Erect CXR
  • CT
  • US
  • ERCP
  • CRP >150mg/L at 36 hours after admission is a predictor of severe pancreatitis
26
Q

describe how amylase rises in acute pancreatitis

A
  • degree of elevation not related to degree of disease
  • may also be normal even in severe pancreatitis (levels start to fall 24-48 hour)
  • excreted renal, so renal failure will increase levels
27
Q

describe what an AXR looks like in acute pancreatitis

A
  • no psoas shadow (increase retroperitoneal fluid)

- sentinel loop - of proximal jejunum an ileus (solitary air-filled dilatation)

28
Q

What is a predictor of severe pancreatitis

A

> 150mg/L at 36h after admission is a predictor of severe pancreatitis

29
Q

describe the modified Glasgow scale and how it is used to work out the severity of acute pancreatitis

A 
3 or more factors detected within 48 hours of onset suggests severe pancreatitis and should prompt transfer to ITU/HDU 
(mnemonic PANCREAS) 
- PaO2 = <8kPa
- Age = >55 years
- Neutrophillia = WBC >15X109/L
- Calcium = <2mmol/L
- Renal function = Urea > 16mmol/L
- Enzyme = LDH>600iu/L; AST>200iu/L
- Albumin = <32g/L
- Sugar = Glucose >10mmol/L
30
Q

Describe the management of acute pancreatitis

A
  • NBM, consider NJ feeding
  • Set of IVI and give lots of crystalloids - to counter third space sequestration, until vital signs are satisfactory and urine flow stays at >30ml/h
  • insert urinary catheter and consider CVP monitoring
  • Analgesia: Pethidine 75-100mg/4h IM or morphine
  • hourly pulse, BP, urine output
  • Daily FBC, U&E, calcium, glucose, amylase, ABG
  • ERCP and gallstone removal if there is progressive jaundice
  • repeat imaging (usually CT) to monitor progress
31
Q

what should you do if the acute pancreatitis is worsening

A
  • ITU
  • oxygen if PaO2 is decreasing
  • if suspected abscess formation or pancreatic necrosis (on CT), consider parenteral nutrition +/- laparotomy and debridement
  • antibiotics can help in severe disease
32
Q

Name the early complications of acute pancreatitis

A
  • Shock
  • ARDS
  • renal failure
  • DIC
  • sepsis
  • calcium decreased
  • increase in glucose
33
Q

What are the late complications of acute pancreatitis

A
  • Pancreatic necrosis and pseudocyst
  • abscesses
  • bleeding - from elastase eroding a major vessel such as a splenic artery
  • thrombosis - may occur in the splenic/gastroduodenal arteries or colic branches of the SMA causing bowel necrosis
  • Fistulae - normally closes spontaneously, if purely pancreatic they do not irritate the skin
  • Recurrent oedematous pancreatitis - may require near-total pancreatectomy
34
Q

What happens in pancreatic necrosis and pseudocyst

A
  • fluid is lesser sac
  • fever and mass +/- persistent increase in amylase/LFT
  • may resolve or need draining
35
Q

What is the difference between mild and severe acute pancreatitis

A
  • mild disease is not associated with complications or organ dysfunction and recovery is uncomplicated
  • severe is characterised by pancreatic dysfunction, local, and systemic complications and a complicated recovery
36
Q

When do you use antibiotics in acute pancreatitis

A

= in severe pancreatitis as a prophylaxis to prevent infection of pancreatic necrosis

37
Q

What is an indication for surgery in acute pancreatitis

A
  • infected pancreatic necrosis is an indicator for surgery or interventional drainage
38
Q

What surgery is offered to patients with acute pancreatitis

A
  • Necrosectomy - stops the progress of infection and release of pro-inflammatory mediators
  • Percutaneous drainage

Year 3 - Met3a (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions