Part two - pancreas

Question 1

Balthazar CT grading of acute pancreatitis

Answer 1

A = normal pancreatitis
B = focal or diffuse enlargement
C - pancreatic gland abnormalities and peripancreatic inflammation
D = single fluid collection or phlegm on
E = 2+ fluid collections and gas bubbles in or adjacent to pancreas

Question 2

Define acute pancreatitis

Answer 2

An acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems

Question 3

Severe acute pancreatitis

Answer 3

Acute pancreatitis associated with organ failure persisting for more than 48 hours

Question 4

Multi organ dysfunction syndrome

Answer 4

Presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention

Question 5

Causes of hyperamylasaemia

Answer 5

• Perforated peptic ulcer
  
  • Cholecysitis
  • Generalised peritonitis
  • Intestinal obstruction
  • Mesenteric infarction
  • Ruptured AAA
  • Ruptured ectopic pregnancy
  • Ovarian tumours
  • Parotitis/siladenitis/salivary tumours
  • Chronic renal failure
  • Macroamylasaemia

Question 6

Pathogenesis of pancreatitis

Answer 6

Autodigestion of the pancreas by inappropriately activated pancreatic enzymes - trypsinogen most importantly.

Trypsin also converts prekalikrein to its activated form such that clotting and complement systems activated.

Inflammation and small vessel thromboses causing congestion and rupture of already weakened vessels

Question 7

Pathogenesis of pancreatitis

Answer 7

Autodigestion of the pancreas by inappropriately activated pancreatic enzymes - trypsinogen most importantly.

Trypsin also converts prekalikrein to its activated form such that clotting and complement systems activated.

Inflammation and small vessel thromboses causing congestion and rupture of already weakened vessels

Question 8

Treatment of pancreatic pseudo cyst with associated pseudo aneurysm

Answer 8

Angioembolisation
Covered stent
USS guided perc thrombin injection
Surgery

Question 9

Sendai criteria for BR-IPMN

Answer 9

High-risk stigmata for malignancy -> surgery

• Jaundice
• Enhancing solid component
• Main PD 10+mm

Worrisome features prompting consideration of surgery

• 3+ cm
• Mural nodule
• Thickened enhancing wall
• Main duct involvement
• Cytology suspicious or positive for malignancy