Pancreatitis and Pancreatic Cancer Flashcards
Acute pancreatitis
Acute pancreatitis is the sudden inflammation and haemorrhaging of the pancreas due to destruction by its own digestive enzymes.
What are the leading causes of acute pancreatitis?
Gallstones
Alcohol abuse
How does alcohol cause acute pancreatitis?
Alcohol increases zymogen secretion from acinar cells while decreasing fluid and bicarbonate production from the ductal epithelial cells. Causes pancreatic secretion to become thick and viscous - this can lead to formation of a plug which can block the duct - similar to the effect of gallstones.
Stimulate acinar cells to release inflammatory cytokines.
How can acute pancreatitis lead to destruction of the pancreatic tissue?
In acute pancreatitis, there is pancreatic tissue destruction that results from the proteases and inflammatory response of the body, and this can cause tiny blood vessels to become leaky and sometimes rupture.
Ultimately, all of the extra fluid or edema causes the capsule of the pancreas to swell, and unfortunately there can be some activation of lipases which go on to destroy the fat around the pancreas, or peripancreatic fat.
All of the digestion and bleeding can actually liquify the pancreatic tissue, a process called liquefactive hemorrhagic necrosis.
What can acute pancreatitis cause due to liquefactive hemorrhagic necrosis?
Pancreatic pseudocyst
How does a pancreatic psuedocyst form?
A pancreatic pseudocyst forms when fibrous tissue surrounds liquefactive necrotic tissue of the pancreas, and this fibrous tissue develops a cavity that fills up with pancreatic juice.
What are the symptoms of a pancreatic pseudocyst?
Abdominal pain
Palpable tender mass
Loss of appetite
What are the complications of acute pancreatitis?
Pancreatic pseudocyst
Hemorrhage of damaged blood vessels
Disseminated intravascular coagulation
Acute respiratory distress syndrome
Explain the effect of disseminated intravascular coagulation due to acute pancreatitis.
Systemic activation of coagulation factors leads to the formation of blood clots throughout the body.
Paradoxically using up this clotting factor makes it easier to bleed.
How does acute pancreatitis lead to acute respiratory distress syndrome?
The massive pancreatic inflammation leads to leaky blood vessels throughout the body - making it hard to breathe.
What are the signs and symptoms of acute pancreatitis?
Nausea Vomiting Hypocalcemia Bruising around the belly button in the umbilical region - 'Cullen's Sign' Pain in the epigastric region Increased serum amylase and serum lipase
What investigations are done for acute pancreatitis?
- why are they done?
CT scan - to look for inflammation, necrosis and pseudocysts.
Ultrasound - may show gallstones.
What is the treatment for acute pancreatitis?
Pain management
Provide fluid and electrolytes.
IV Nourishment in place of eating food.
Treat complications with oxygen therapy and antibiotics if needed.
What causes hereditary pancreatitis?
Mutation to the trypsinogen molecule, which makes it much more easily activated.
What are the causes of acute pancreatitis?
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion stings Hypercalcemia, hyperlipidemia, hyperthermia ERCP Drugs
What is the basic pathology of acute pancreatitis?
Influx of Ca2+ causes early activation of trypsinogen in the acinar cell leading to pancreatitis.
Chronic pancreatitis
Chronic pancreatitis is the constant inflammation of the pancreas, often due to repeated bouts of acute pancreatitis.
What causes chronic pancreatitis?
Chronic pancreatitis is inflammation due to irreversible changes to the pancreatic structure, like fibrosis, atrophy and calcification.
What is the main cause of chronic pancreatitis in children?
Cystic fibrosis
How does pain present in chronic pancreatitis?
Continuous / Intense intermittent abdominal pain in the epigastric region that sometimes radiates to the back.
How is chronic pancreatitis diagnosed?
Reliance on imaging studies which can identify the structural changes to the pancreas.
- X-rays and CT scans may show calcification of the pancreas.
- ERCP
ERCP
Endoscopic retrograde cholangiopancreatography - used to visualise the pancreatic ducts.
What are the symptoms of chronic pancreatitis?
Epigastric pain that radiates to the back.
Pancreatic insufficiency - leading to weightloss and Vitamin deficiency.
Deficient in the fat soluble vitamins A, D, E and K - leads to fat not being digested and passing through the bowel causing steatorrhoea.
What is a long term consequence of chronic pancreatitis?
Development of diabetes mellitus.
Pancreatic cancer.
Pseudocysts.
Brittle bones due to lack of vitamin D.
How is chronic pancreatitis treated?
Controlling pain.
Controlling the risk factors - e.g drinking less alcohol, eating less meat and reducing obesity.
Pancreatic enzyme replacement therapy.
95% of pancreatic tumours develop where in the pancreas?
The exocrine tissues.
- majority of cases occur in the epithelial cells lining the ducts.
- typically in the neck / head of the pancreas.
What are some of the risk factors of pancreatic cancer?
Smoking Obesity Diet high in red meat Diabetes Chronic pancreatitis Liver cirrhosis
What are the symptoms of pancreatic cancer?
Nausea Vomiting Fatigue Weight loss Midepigastric pain - radiates to mid / lower back Trousseau sign of Malignancy. Courvoiser's sign Darker urine and jaundice due to obstructed bile duct.
Trousseau sign of malignancy
When blood clots, that can be felt as small lumps under the skin, appear unexpectedly in superficial veins, and then over time, migrate to different locations.
Courvoiser’s sign
When the gallbladder is enlarged and palpable - yet not tender (unlike gallstones).
What causes Courvoiser’s sign?
A tumour in the head of the pancreas, which obstructs the common bile duct.
How is pancreatic cancer diagnosed?
Medical imaging and biopsy.
- note imaging can also help determine if the cancer is resectable.
Whipple’s procedure
The Whipple procedure (pancreaticoduodenectomy) is an operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.
Grey Turners sign:
Grey Turner sign is a discoloration of the left flank associated with acute haemorrhagic pancreatitis.
Cullen’s sign:
Cullen sign is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage from any cause; one of the more frequent causes is acute hemorrhagic panniculitis.
