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The Gastrointestinal System 2023 > Pancreatitis and Pancreatic Tumours > Flashcards

Pancreatitis and Pancreatic Tumours Flashcards

1
Q

What are the two types of functioning cells in the pancreas?

A
  1. Exocrine - acinar cells secrete pancreatic enzymes
  2. Endocrine - islets of Langerhans secrete hormones into the blood
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2
Q

What are the 4 cell types in the pancreas?

A
  1. Beta cells - secrete insulin
  2. Alpha cells - secrete glucagon
  3. Delta cells - secrete somatostatin
  4. PP cells - secrete polypeptides
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3
Q

In relation to the pancreas function only, what impact does somatostatin have?

A

Suppression of pancreatic hormones and also the exocrine function of the pancreas

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4
Q

What is the purpose of pancreatic polypeptides released from PP cells?

A

It is a self-regulatory mechanism to limit the secretions from the pancreas

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5
Q

Besides pancreatic polypeptides, which other factors can control pancreatic secretions?

A
  1. Vagus nerve
  2. Parasympathetic activity
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6
Q

What is the function of proteases?

A

Break down proteins from polypeptides to peptides

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7
Q

What is the function of pancreatic lipase?

A

Break down fat

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8
Q

Which two sources in the body does pancreatic lipsase come from?

A
  • Saliva
  • Pancreas
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9
Q

What does amylase in the body function to do?

A

Break down dietary starch and complex carbohydrates into di and trisaccharides

(additional enzymes can complete the breakdown process to form glucose)

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10
Q

Where is pancreatic lipase released?

A

Small intestine

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11
Q

Pancreatitis can be one of two things depending on the length of onset, what are these?

A
  1. Acute
  2. Chronic
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12
Q

What is the aetiology of acute pancreatitits?

A

I GET SMASHED

I - Idiopathic

G - Gallstones

E - Ethanol

T - Trauma

S - Steroids

M - Mumps

A - Autoimmune

S - Scorpion bites

H - Hyperlipidaemia, hyperparathyroidism, hypercalcaemia

E - ERCP

D - Drugs - azathioprine

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13
Q

What causes trypsin in the pancreas to be prematurely activated?

A

Damage to acinar cells

Blockage or occulsion preventing drainage out of the main pancreatic duct into the ampulla of Vater

Potentiall high levels of intracellular calcium

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14
Q

Which may cause high levels of intracellular calcium leadign to pancreatitits?

A
  • Disruption in calcium homeostasis from alcohol consumption
  • Duct hypertension from occulsion
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15
Q

Where will pain present in acute pancreatitis?

A

Epigastrium

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16
Q

What may be found on clinical examination in patient with pancreatitits?

A
  • Fullness and pain in epigastrium
  • Diffuse upper abdominal tenderness
  • Soft
  • Normal
  • Tachycardia
  • Hypotension
  • Oliguric (very low urine output)
  • Cullen’s, Grey-Turner’s signs and erythema ab igne
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17
Q

Which blood tests are required for acute pancreatitis?

A
  • Serum amylase - may be normal, but can be high
  • Serum lipase - remains elevated for longer than serum amylase
  • CRP - can assess severity of inflammation
  • Others
18
Q

When would serum amylase levels be diagnostic of pancreatitits?

A

When they are raised 3 fold

19
Q

Why may urinary amylase be useful?

A

It remains elevated for longer than serum amylase

20
Q

ERCP can be used as a method to diagnose pancreatitis

True or false?

A

False

21
Q

Name one method which can be used to assess the severity of pancreatitis?

A

The Glasgow Criteria

22
Q

What are the components of the Glasgow criteria?

A
  • PaO2 < 8kPa (60mmhg)
  • Age > 55 years
  • Neutrophils: (WBC >15 x109/l
  • Calcium < 2mmol/l
  • Renal function: (Urea > 16mmol/l)
  • Enzymes: (AST/ALT > 200 iu/L or LDH > 600 iu/L)
  • Albumin < 32g/l
  • Sugar: (Glucose >10mmol/L)
23
Q

How often are patients rescored for the severity of their pancreatitis?

A

After 24 hours

24
Q

What are pseudocysts?

A

Cystic lesions lacking epithelial or endothelial cells - they are cmposed of a pocket of pancreatic fluid between pancreatic and fibrous/granular tissue

25
Q

How are pseudocysts treated?

A
  • Endoscopic drainage
  • Stent insertion to compress cysts
26
Q

Why must abscesses be drained?

A

They can potentially lead to sepsis

27
Q

How is pancreatic necrosis assessed and treated?

A

Assessed by CT

Fine needle aspiration can allow for investigation of tissue

Percutaneous drainage can remove some tissue

Necrosectomy by endoscopy and lavage can remove infected tissue

28
Q

What are common causes for chronic pancreatitis?

A

Alcohol is the main cause

Smoking and medication

29
Q

What is often found on examination for chronic pancreatitis?

A

Masses, ascites, jaundice

30
Q

What is the full aetiology for chronic pancreatitis?

A

CAT And PIG

  • Congenital and acquired
  • Alcohol
  • Tropical countries
  • Autoimmune
  • Pancreatic duct obstruction
  • Idiopathic
  • Genetics – cystic fibrosis
31
Q

Pancreatic stones are indicative of which type of chronic pancreatitis?

A

Tropical pancreatitis

32
Q

What are the main symtoms for chronic pancreatitits?

A
  • Bloating
  • Pain
  • Loose fatty stools
  • Weight loss
  • Increased stool frequency
33
Q

How can chronic pancreatitis be treated?

A

CREON - enzyme replacement therapy

34
Q

Pseudocyts can cause what types of obstruction in relation to the pancreas?

A
  • Biliary obstruction
  • Gastric outflow obstruction
35
Q

What are the two main classes of pancreatic tumours based on cell types affected?

A
  1. Exocrine
  2. Endocrine
36
Q

Almost all exocrine tumours will be what type of tumour?

A

Adenocarcinoma

37
Q

What are risk factors for exocrine tumours of the pancreas?

A
  • Smoking
  • Alcohol excess
  • High coffee intake
  • Use of aspirin
38
Q

Give examples of endocrine tumours and the effects they will have

A

Gastrinoma - produces gastrin - increases acid

Insulinoma - produces insulin - causes hypoglycaemia

Glucagonoma - produces glucagon - cause hyperglycaemia

Vasoactive intestinal peptide tumour (VIPoma) - VIP produced causing severe secretory diarrhoea

Somatostatinoma - can cause diabetes, gallstones and steatorrhoea

39
Q

Endocrine tumours may present with signs such as what?

A
  • Jaundice
  • Loose pale stools
  • Dark urine
  • Weight loss
  • Back pain
40
Q

What are the risk factors for endocrine pancreatic tumours?

A
  • Heavy smokers
  • Charred meat
  • Obesity
  • Diabetes (types I and II)
41
Q

How may pancreatic tumours be treated?

A
  • ERCP or PTC (percutaneous transhepatic cholangiograhy) and stent instertion
  • Surgery

The Gastrointestinal System 2023 (27 decks)

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