The Pancreas

Question 1

Acute pancreatitis definition

Answer 1

Previously normal pancreas

Returns to normal after restitution

Question 2

Acute pancreatitis aetiology

Answer 2

70-80% stones or alcohol
>45
Females

Steriods and sulphonamides
Azothioprine
NSAID’s
Diuretics

Iatrogenic
Hypermetabolic states
AIDS
Idiopathic

Question 3

Acute pancreatitis pathology

Answer 3

Activation of pancreatic enzymes within the pancreas-> increased Ca2+
-> interstitial oedematous pancreatitis -> no signs on CT-> usually resolves
May progress to necrosis -> ischaemic and repercussion injury
*fat necrosis
-> SIRS
Necrotic pancreas may become infected, gram neg -> abcess

Acute haemorrhagic pancreatitis

Question 4

Acute pancreatitis clinical features

Answer 4

Sudden onset pain in the epigastrium
Nausea and vomiting

Mild:

• mild discomfort
• abdo distension
• rapidly resolving signs
• minimal systemic illness

Severe: 20-30% mortality

• severe pain
• shock
• peritonitis
• guarding
• ARDS

-

Question 5

Acute pancreatitis investigations

Answer 5

Pancreatic enzymes
-plasma amylase >4x upper limit within 24h
-urinary amylase remains elevated for longer
-serum lipase, remains raised for 4-7 days
Raised CRP etc

USS-> swelling and necrosis
Contrast CT after 72h to asses necrosis -> prognosis
Endoscopy -undecided diagnosis

Question 6

Ransom and Glasgow score

Answer 6

Pa O2 <8
Age >55y
Neutrophils >15
Calcium <2
RenalUrea >16
Enzyme LDH >600
Albumin <32
Sugar Glucose >10

First 48h >3 =severe episode

• BMI >30
• pleural effusion
• organ failure

Question 7

Acute pancreatitis differentials

Answer 7

Billary colic
Acute cholecystitis
Peptic ulcer
Lower love pneumonia

Question 8

Acute pancreatitis management

Answer 8

IV fluids 
Nil by mouth 
NG tube
Analgesia 
Severe requires antibiotics
-urgent ERCP and sphincterotomy 
-organ support 
-correct ca

Question 9

Acute pancreatitis complication

Answer 9

Shock
Organ failure
Hypocalcemia
Hyperglycaemia
Necrosis
Paralytic ileus
GI bleed
GI obstruction

Question 10

Chronic pancreatitis aetiology

Answer 10

80% alcohol
Tumours
Duct stricture

Question 11

Chronic pancreatitis clinical features

Answer 11

Chronic epigastrium pain 
Wt loss
Anorexia
Opiate addiction 
Depression 
DM

Question 12

Chronic pancreatitis investigations

Answer 12

Glucose tolerance
Calcifications on x Ray
USS/CT duct dilatation, calcification, cysts

Question 13

Chronic pancreatitis managment

Answer 13

Stop drinking alcohol
Pain managment
Insulin

Question 14

Pancreatic pseudo cysts

Answer 14

Inflammatory duct dilation
No epithelial lining
Abdo pain
Usually resolve

Question 15

Pancreatic cancer aetiology

Answer 15

Smoking 
Excess alcohol
Diabetes
Chronic pancreatitis 
FH 
Obesity 
>60y 
Male

Question 16

Pancreatic cancer pathology

Answer 16

Adenocarcinoma from duct all cells
70% in head
Highly malignant
Metastasise earlŷ to local lymph nodes

Question 17

Pancreatic cancer clinical features

Answer 17

Wt loss 
Abdo pain, deep and knawing
Obstructive jaundice -> head of pancreas 
Acute pancreatitis 
DM
Gastric outlet obstruction 
Courserviers sign

Question 18

Pancreatic cancer spread

Answer 18

Lung
Liver
Local lymph
Duodenum

Question 19

Pancreatic cancer investigations

Answer 19

LFT’s obstructive
Glucose tolerance
USS/endoscopic
CT staging

Question 20

Pancreatic cancer managment

Answer 20

Rarely resectable
Endoscopic stent
Pain relief
50% die within 6w