Week 122 Biliary Pancreatic Function

Question 0

WHAT IS THE IMMEDIATE MANAGEMENT OF ACUTE PANCREATITIS?

Answer 0

INSPIRED O2 TO CORRECT HYPOXIA
FLUID/COLLOID/BLOOD - CORRECT HAEMODYNAMICS
FLUID BALANCE MONITORING - CATHETER
CORRECTION OF ELECTROLYTE IMBALANCE - INSULIN MAY BE REQUIRED
NG TUBE & NBM
IV ANTIBIOTICS ONLY IF BACTERAEMIA
BLOOD PRODUCTS IF BLEEDING WITH DIC

Question 1

WHAT FACTORS INDICATE A POOR OUTCOME WITH ACUTE PANCREATITIS?

Answer 1

AGE >55
WBC > 15 X 10 ^9/L
BLOOD GLUCOSE >10MMOL/L
ALBUMIN < 30G/L
CALCIUM < 2MMOL/L
ASPARATE AMINOTRANSFERASE (AST) > 100 IU/L
LDH > 600 IU/L (LACTATE DEHYDROGENASE)
PAO2 < 8KPA

Question 2

NAME THE CAUSES OF PANCREATITIS.

Answer 2

ALCOHOL
GALLSTONES
DRUGS (I.E. CORTICOSTEROIDS)
INFECTIONS
METABOLIC (I.E. HYPERCALCAEMIA & HYPERLIPIDAEMIA)
IATROGENIC (I.E. POST-ERCP, POST SURGICAL)
TRAUMA/SCORPION BITE

Question 3

WHAT ARE THE EARLY COMPLICATIONS OF ACUTE PANCREATITIS?

Answer 3

ARDS - RARE BUT SEVERE
DISSEMINATED INTRAVASCULAR COAGULATION
METABOLIC ABNORMALITIES I.E. HYPOCALCAEMIA &HYPERGLYCAEMIA
PARALYTIC ILEUS

Question 4

WHAT INVESTIGATIONS WOULD YOU CONDUCT IF YOU HAD A PATIENT WITH CHRONIC PANCREATITIS?

Answer 4

SERUM AMYLASE - NOT USUALLY RAISED IN CHRONIC, BUT IS IN ACUTE.

• SERUM GLUCOSE (LOOK FOR < ALCOHOL)
• ABDO X-RAY - PANCREATIC CALCIFICATION
• CT/ SWELLING, PSEUDOCYST FORMATION
• ERCP - DISTORTED & IRREGULAR PANCREATIC DUCTS (INDICATIVE OF FIBROSIS)

Question 5

WHAT IS COURVOISLES LAW?

Answer 5

WITH PAINLESS OBSTRUCTIVE JAUNDICE, PALPABLE GALL BLADDER SUGGESTS CANCER.

NB: WITH FIBROTIC REACTION, GALL BLADDER SHRINKS INSTEAD!

Question 6

WHICH GENE IS MUTATED IN CYSTIC FIBROSIS?

Answer 6

MUTATION OF LONG ARM OF CHROMOSOME 7, RESULTING IN ABNORMALITY OF TRANSMEMBRANE PROTEIN KNOWN AS CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR.

Question 7

WHAT IS ZOLLINGER-ELLISON SYNDROME?

Answer 7

GASTRINOMAS
G CELLS OF PANCREAS SECRETE GASTRIN CAUSING:
 - PEPTIC ULCERATION
- PERFORATION & GI HAEMMORHAGE
- DIARRHOEA DUE TO EXCESS ACID

Question 8

WHAT DOES SOMATOSTATIN DO?

Answer 8

AN INHIBITORY HORMONE THAT PRODUCES A REDUCTION IN PRODUCTION OF INSULIN, PANCREATIC ENZYME AND BICARBONATE.

Question 9

WHAT ARE THE SYMPTOMS OF A SOMATOSTATINOMA?

Answer 9

STEATORRHEA
HYPOCHLORIDIA
(WEIGHT LOSS ALSO COMMON)

Question 10

DESCRIBE THE FUNCTION OF THE PANCREAS. (CLUE - THERE ARE TWO!)

Answer 10

EXOCRINE: SECRETES LIPASE, AMYLASE & PROTEASES WHICH ARE RESPONSIBLE FOR DIGESTION OF FAT, CARBOHYDRATE AND PROTEIN.

ENDOCRINE: INSULIN, GLUCAGON AND SOMATOSTATIN PRODUCTION AND RELEASE.

Question 11

WHAT IS M.E.N?

Answer 11

MULTIPLE ENDOCRINE NEOPLASIA

TWO TYPES (I&II)

TYPE II IS AUTOSOMAL DOMINANT INHERITANCE.

Question 12

WHAT IS PRIMARY SCLEROSING CHOLANGITIS, AND WHAT DOES IT CAUSE?

Answer 12

UNKNOWN AETIOLOGY
CAUSES FIBROSIS & BLOCKAGE
INFLAMED BILED DUCTS
UNCOMMON

Question 13

CHOLESYSTIKININ STIMULATES RELEASE OF ENZYMES FROM WHERE?

Answer 13

PANCREAS