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Acute Pancreatitis Pancreatic Cancer l8
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Acute Pancreatitis Pancreatic Cancer l8

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Questions and Answers

What is the overall mortality rate associated with acute pancreatitis?

  • 15%
  • 25%
  • 5%
  • 10% (correct)

    • Which of the following is NOT a recognized cause of pancreatitis according to the mnemonic 'I GET SMASHED'?

  • Gallstones
  • Obesity (correct)
  • Alcohol
  • Mumps

    • In the context of acute pancreatitis, what is the first event in the pathogenesis process?

  • Release of cytokines
  • Release of pancreatic enzymes like lipase and trypsin
  • Activation of pancreatic enzymes secondary to injury (correct)
  • Local and systemic inflammatory response

    • What is a common presentation seen in patients with acute pancreatitis?

    <p>Abdominal pain</p> Signup and view all the answers

    Which factor is associated with a cytokine storm in the pathogenesis of acute pancreatitis?

    <p>Release of pancreatic enzymes</p> Signup and view all the answers

    Which of the following signs is indicative of cholangitis?

    <p>Jaundice</p> Signup and view all the answers

    Which criteria are used to predict the severity of acute pancreatitis?

    <p>Glasgow IMRIE Criteria</p> Signup and view all the answers

    Which condition is not a complication of acute pancreatitis?

    <p>Gastro-oesophageal reflux disease</p> Signup and view all the answers

    What imaging technique is best for assessing gallstones in the gallbladder?

    <p>Ultrasound abdomen</p> Signup and view all the answers

    What is the primary treatment focus in managing chronic pancreatitis?

    <p>Enzyme supplementation and dietary modifications</p> Signup and view all the answers

    Which sign specifically indicates severe hemorrhagic pancreatitis?

    <p>Grey Turner's sign</p> Signup and view all the answers

    Which statement about pancreatic cancer is correct?

    <p>Mean survival for bypassed patients is 6 months.</p> Signup and view all the answers

    Which is a common risk factor for pancreatic cancer?

    <p>Chronic pancreatitis</p> Signup and view all the answers

    What is the main indication for surgery in patients with chronic pancreatitis?

    <p>Intractable pain</p> Signup and view all the answers

    What condition may present with signs including Cullen’s sign and Grey Turner’s sign?

    <p>Hemorrhagic pancreatitis</p> Signup and view all the answers

    Which symptom is not typically associated with pancreatic cancer?

    <p>Acute epigastric pain</p> Signup and view all the answers

    Which of the following stages is crucial for assessing the severity of necrotizing pancreatitis?

    <p>First week: Severe SIRS</p> Signup and view all the answers

    Which of the following is a non-invasive method for acute pancreatitis management?

    <p>Oxygen therapy and IV fluids</p> Signup and view all the answers

    Which condition can be a cause of recurrent acute pancreatitis?

    <p>Pancreatic duct obstruction</p> Signup and view all the answers

    Which of the following best describes the blood supply to the pancreas?

    <p>Celiac trunk and superior mesenteric artery</p> Signup and view all the answers

    If the main pancreatic duct is inflamed, which structure takes over its function?

    <p>Accessory pancreatic duct</p> Signup and view all the answers

    What makes acute pancreatitis a systemic disease?

    <p>Release of pancreatic enzymes into the bloodstream</p> Signup and view all the answers

    How does acute pancreatitis lead to oxygen starvation in the body?

    <p>Hypoxia from a cytokine storm and systemic inflammatory response</p> Signup and view all the answers

    What is the mnemonic used to recall the causes of pancreatitis?

    A) I GET SMASHED B) PANCREAS C) CAUSES D) DIGEST

    <p>I GET SMASHED</p> Signup and view all the answers

    What is the most common cause of acute pancreatitis?

    <p>Alcohol and gallstones</p> Signup and view all the answers

    Which of the following best explains the pathogenesis of acute pancreatitis?

    <p>Autodigestive process where pancreatic enzymes activate prematurely</p> Signup and view all the answers

    Which pancreatic enzymes are responsible for initiating the autodigestion process in acute pancreatitis?

    <p>Lipase and trypsin</p> Signup and view all the answers

    Which of the following are common symptoms of acute pancreatitis? (Select all that apply)

    <p>Epigastric pain</p> Signup and view all the answers

    What characteristic describes the epigastric pain in acute pancreatitis?

    <p>Rapid onset, radiates to the back, relieved by sitting forward</p> Signup and view all the answers

    What is the pathogenesis of acute pancreatitis caused by duct obstruction?

    <p>Buildup of pressure leading to ischemia and inflammation</p> Signup and view all the answers

    Which of the following signs are characteristic of hemorrhagic pancreatitis?

    <p>Cullen's sign and Grey Turner's sign</p> Signup and view all the answers

    Which symptom is most related to the radiation of pain in acute pancreatitis?

    <p>Radiates to the back, often described as 'band-like'</p> Signup and view all the answers

    Which clinical features suggest the presence of cholangitis (bile duct inflammation) in a patient with acute pancreatitis?

    <p>Charcot's triad: jaundice, RUQ pain, and pyrexia</p> Signup and view all the answers

    What does a patient presenting with rigors and epigastric pain suggest in the context of pancreatitis?

    <p>Severe cholangitis</p> Signup and view all the answers

    Which of the following is used to stratify the severity of acute pancreatitis?

    <p>Glasgow (Imrie) Criteria</p> Signup and view all the answers

    Which of the following is NOT part of the Glasgow (Imrie) Criteria for assessing the severity of acute pancreatitis?

    <p>Serum potassium &lt;3.5 mmol/L</p> Signup and view all the answers

    Which component of the Glasgow (Imrie) Criteria assesses renal function in acute pancreatitis?

    <p>Blood urea &gt;16 mmol/L</p> Signup and view all the answers

    In the Glasgow (Imrie) Criteria, what blood glucose level indicates a worse prognosis for acute pancreatitis?

    <blockquote> <p>10 mmol/L</p> </blockquote> Signup and view all the answers

    Which lab value from the Glasgow (Imrie) Criteria is associated with hypocalcemia in severe acute pancreatitis?

    <p>Calcium &lt;2 mmol/L</p> Signup and view all the answers

    What does Grey Turner’s sign (flank bruising) indicate in a patient with acute pancreatitis?

    <p>Retroperitoneal hemorrhage</p> Signup and view all the answers

    In the context of acute pancreatitis, which of the following signs is characterized by peri-umbilical bruising?

    <p>Cullen’s sign</p> Signup and view all the answers

    A Glasgow (Imrie) Criteria score of greater than 3 suggests which of the following regarding the severity of acute pancreatitis?

    <p>Severe pancreatitis, requiring high dependency or ICU care</p> Signup and view all the answers

    Which of the following is part of the management for a patient with a Glasgow (Imrie) score of greater than 3?

    <p>Admission to high dependency or ICU with hourly monitoring of vital signs</p> Signup and view all the answers

    In the Glasgow (Imrie) Criteria, what is the minimum score required to predict severe disease in acute pancreatitis?

    <p>3</p> Signup and view all the answers

    Which of the following is the most specific enzyme for diagnosing acute pancreatitis?

    A) Serum amylase B) Serum lipase C) Urinary amylase D) Serum LDH

    <p>Serum lipase</p> Signup and view all the answers

    What is the significance of free air under the diaphragm on a chest X-ray (CXR) in a patient with acute abdominal pain?

    <p>Perforated viscus (e.g., perforated peptic ulcer)</p> Signup and view all the answers

    In acute pancreatitis, a CT scan of the pancreas is typically done after how many days to assess the severity and complications?

    <p>After 3 days</p> Signup and view all the answers

    Which of the following imaging techniques is commonly used to check for gallstones in a patient with suspected acute pancreatitis?

    <p>Ultrasound of the abdomen</p> Signup and view all the answers

    Which of the following laboratory tests would you include to assess a patient with acute pancreatitis for electrolyte imbalances and renal function?

    <p>Liver function tests (LFTs) and Urea &amp; Electrolytes (U&amp;E)</p> Signup and view all the answers

    In a patient with acute pancreatitis, beta-hCG is included in the workup to:

    A) Assess for pancreatitis severity B) Diagnose possible pregnancy C) Assess renal function D) Monitor blood glucose levels

    <p>Diagnose possible pregnancy</p> Signup and view all the answers

    What laboratory test is useful in assessing for inflammatory markers in acute pancreatitis?

    <p>C-reactive protein (CRP)</p> Signup and view all the answers

    An ECG is performed in patients with acute pancreatitis to rule out:

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the primary role of ultrasound in the management of acute pancreatitis?

    <p>To assess for pancreatic necrosis</p> Signup and view all the answers

    Which of the following findings on ultrasound would require an expert ultrasonologist?

    <p>Stone in the pancreatic duct</p> Signup and view all the answers

    Which of the following is NOT typically included in the acute management of mild to moderate acute pancreatitis? (Select one)

    <p>Immediate surgical intervention</p> Signup and view all the answers

    What is the recommended approach to feeding in a patient with acute pancreatitis?

    <p>Introduce feeding when possible, as soon as pain improves</p> Signup and view all the answers

    In acute pancreatitis patients with pancreatic necrosis, which of the following is the first-line antibiotic treatment?

    <p>Meropenem</p> Signup and view all the answers

    Why is it important to be aware of alcohol withdrawal in patients with acute pancreatitis?

    A) It can increase the risk of gallstone formation B) It can complicate management with symptoms like seizures C) It requires immediate surgical treatment D) It can cause sudden respiratory failure

    <p>It can complicate management with symptoms like seizures</p> Signup and view all the answers

    In the Glasgow Imrie score, how often should the score be reassessed to evaluate the severity of acute pancreatitis?

    <p>At 48 hours</p> Signup and view all the answers

    Which of the following is included in antithrombotic prophylaxis for patients with acute pancreatitis?

    A) Aspirin B) Heparin C) Warfarin D) Clopidogrel

    <p>Heparin</p> Signup and view all the answers

    In the context of acute pancreatitis, why is it important to monitor for alcohol withdrawal?

    <p>Alcohol withdrawal can complicate treatment with seizures and delirium tremens</p> Signup and view all the answers

    Which of the following medications is typically used to manage alcohol withdrawal in a patient with acute pancreatitis?

    <p>Chlordiazepoxide</p> Signup and view all the answers

    Pabrinex is often used in the management of patients experiencing alcohol withdrawal. What is its primary role?

    <p>To replace essential vitamins like thiamine and prevent Wernicke’s encephalopathy</p> Signup and view all the answers

    Which of the following is a serious complication of alcohol withdrawal that must be prevented during the treatment of acute pancreatitis?

    A) Hypokalemia B) Delirium tremens C) Acute renal failure D) Hypercalcemia

    <p>Delirium tremens</p> Signup and view all the answers

    In patients with alcohol withdrawal, chlordiazepoxide is preferred over other benzodiazepines because:

    <p>It has a longer half-life and smoother withdrawal</p> Signup and view all the answers

    Which of the following is NOT a routine part of the initial management of acute pancreatitis?

    <p>Immediate surgical intervention</p> Signup and view all the answers

    In the management of acute pancreatitis, what is the primary purpose of administering IV fluids?

    <p>To maintain urine output and prevent dehydration</p> Signup and view all the answers

    In patients with acute pancreatitis, when should feeding be introduced?

    <p>As soon as the patient’s condition allows and symptoms improve</p> Signup and view all the answers

    Which of the following is a key factor in monitoring patients with acute pancreatitis to assess the progression of the disease?

    <p>Monitoring vital signs, including urine output and oxygen levels</p> Signup and view all the answers

    Which of the following complications should be monitored and managed during the acute phase of pancreatitis?

    <p>Respiratory distress and organ failure</p> Signup and view all the answers

    In acute pancreatitis, analgesia is administered primarily to:

    <p>Relieve pain and discomfort</p> Signup and view all the answers

    Which of the following is a respiratory complication that can develop in severe cases of acute pancreatitis?

    <p>ARDS (Acute Respiratory Distress Syndrome)</p> Signup and view all the answers

    Pseudocyst formation is a complication of acute pancreatitis. It is characterized by:

    A) Fluid collection with a well-formed wall outside the pancreas B) A collection of infected pancreatic tissue C) Gallstone formation within the pancreas D) A malignant transformation of pancreatic cells

    <p>Fluid collection with a well-formed wall outside the pancreas</p> Signup and view all the answers

    Which of the following complications of acute pancreatitis involves infection and accumulation of pus?

    <p>Pancreatic abscess</p> Signup and view all the answers

    Which complication of acute pancreatitis results from the death of pancreatic tissue?

    <p>Necrotising pancreatitis</p> Signup and view all the answers

    In acute pancreatitis, acute kidney injury (AKI) is most commonly due to:

    <p>Dehydration and hypovolemia</p> Signup and view all the answers

    Which of the following metabolic complications can occur in patients with acute pancreatitis?

    A) Hypokalemia and hypernatremia B) Hyperglycemia and hypocalcemia C) Hypercalcemia and hyperglycemia D) Hyponatremia and hypokalemia

    <p>Hyperglycemia and hypocalcemia</p> Signup and view all the answers

    Which of the following gastrointestinal complications is associated with necrosis of the transverse colon in severe acute pancreatitis?

    <p>Ischemic colitis</p> Signup and view all the answers

    Which haemorrhagic complication can develop in severe acute pancreatitis? A) Intracranial bleeding B) Pancreatic haemorrhage C) Duodenal ulcer bleeding D) Esophageal varices

    <p>Pancreatic haemorrhage</p> Signup and view all the answers

    Chronic pancreatitis is a complication of acute pancreatitis. What is the most common long-term consequence of chronic pancreatitis?

    <p>Chronic abdominal pain and digestive enzyme insufficiency</p> Signup and view all the answers

    What is the approximate mortality rate associated with severe acute pancreatitis and complications like necrotising pancreatitis and multiple organ failure?

    <p>10-30%</p> Signup and view all the answers

    Necrotizing pancreatitis is typically a two-phase disease. What occurs during the first phase (1-2 weeks)?

    <p>Severe systemic inflammatory response syndrome (SIRS) due to cytokine release</p> Signup and view all the answers

    The second phase of necrotizing pancreatitis, which occurs after 2 weeks, is primarily characterized by:

    <p>Sepsis-related complications due to infected pancreatic necrosis</p> Signup and view all the answers

    Which of the following is a primary cause of sepsis in the second phase of necrotizing pancreatitis?

    <p>Bacterial infection of necrotic pancreatic tissue</p> Signup and view all the answers

    Systemic Inflammatory Response Syndrome (SIRS) during necrotizing pancreatitis leads to which of the following systemic effects?

    <p>Multi-organ dysfunction</p> Signup and view all the answers

    What is the primary clinical risk associated with necrotizing pancreatitis during the second phase of the disease?

    <p>Infected pancreatic necrosis and sepsis</p> Signup and view all the answers

    Which of the following is NOT a common feature of necrotizing pancreatitis?

    <p>Painless jaundice</p> Signup and view all the answers

    What imaging modality is typically used to assess necrosis in patients with suspected necrotizing pancreatitis after the initial phase?

    <p>CT scan with contrast</p> Signup and view all the answers

    Why does ARDS (Acute Respiratory Distress Syndrome) occur in patients with severe acute pancreatitis?

    <p>As a result of systemic inflammatory response syndrome (SIRS) causing widespread inflammation and fluid leakage into the lungs</p> Signup and view all the answers

    How does a pancreatic pseudocyst form after an episode of acute pancreatitis?

    A) By the accumulation of infected pancreatic tissue B) As a result of pancreatic enzymes leaking into surrounding tissues, causing a collection of fluid that becomes walled off C) Due to obstruction of the common bile duct D) Through viral infection of pancreatic tissue

    <p>As a result of pancreatic enzymes leaking into surrounding tissues, causing a collection of fluid that becomes walled off</p> Signup and view all the answers

    What leads to the formation of a pancreatic abscess in the course of acute pancreatitis?

    <p>Bacterial infection of a necrotic area or pseudocyst within the pancreas</p> Signup and view all the answers

    Why does necrotizing pancreatitis occur in some patients with acute pancreatitis?

    <p>Due to severe inflammation causing ischemia and tissue death in the pancreas</p> Signup and view all the answers

    Why does pancreatic hemorrhage sometimes occur in acute pancreatitis?

    <p>Pancreatic enzymes degrade blood vessels, leading to bleeding within and around the pancreas</p> Signup and view all the answers

    How does acute pancreatitis lead to chronic pancreatitis in some patients? (Select one correct answer)

    <p>Recurrent inflammation and injury to the pancreas cause permanent damage and fibrosis</p> Signup and view all the answers

    Why can hyperglycemia develop as a metabolic complication of acute pancreatitis?

    <p>Insulin secretion by the pancreas is impaired due to damage to the pancreatic islet cells</p> Signup and view all the answers

    What leads to hypocalcemia in patients with acute pancreatitis?

    <p>Calcium sequestration in necrotic fat (saponification) due to lipase release</p> Signup and view all the answers

    How can acute pancreatitis cause necrosis of the transverse colon? (Select one option)

    <p>Pancreatic inflammation and enzymes spread to adjacent tissues, including the colon, leading to ischemia and necrosis</p> Signup and view all the answers

    In the acute management of acute pancreatitis, what is the first-line treatment aimed at stabilizing the patient?

    <p>IV fluids</p> Signup and view all the answers

    Which of the following is an essential component of initial management in acute pancreatitis to ensure adequate oxygenation?

    <p>Oxygen therapy</p> Signup and view all the answers

    The Glasgow IMRIE score is used to assess the severity of acute pancreatitis. What does a score greater than 3 indicate?

    <p>Severe disease requiring high dependency or ICU care with hourly monitoring</p> Signup and view all the answers

    What is the primary purpose of using severity assessment tools like the Glasgow criteria and APACHE II score in patients with necrotizing pancreatitis?

    <p>To guide surgical intervention and predict outcomes</p> Signup and view all the answers

    In the management of necrotizing pancreatitis, what is the role of pancreatic necrosis percutaneous needle aspiration?

    <p>To obtain a sample for culture and identify infection in necrotic tissue</p> Signup and view all the answers

    What distinguishes infected necrosis from sterile necrosis in the context of necrotizing pancreatitis?

    <p>The presence of bacterial colonization in infected necrosis</p> Signup and view all the answers

    Which of the following management strategies is typically preferred for sterile necrosis in necrotizing pancreatitis?

    <p>Non-operative management with observation and supportive care</p> Signup and view all the answers

    What does an elevated C-reactive protein (CRP) level indicate in the context of necrotizing pancreatitis?

    <p>The presence of inflammation and possible infection</p> Signup and view all the answers

    How is a dynamic CT scan utilized in the management of necrotizing pancreatitis?

    <p>To assess for complications such as necrosis and determine the need for intervention</p> Signup and view all the answers

    What percentage of acute pancreatitis-associated mortality is attributed to infected pancreatic necrosis?

    <p>80%</p> Signup and view all the answers

    In the context of surgical management of necrotizing pancreatitis, which of the following statements is true regarding infected pancreatic necrosis?

    <p>It is the primary cause of mortality in acute pancreatitis.</p> Signup and view all the answers

    Which of the following is a key indication for surgical intervention in patients with infected pancreatic necrosis?

    <p>Evidence of infection in necrotic tissue</p> Signup and view all the answers

    What is the preferred surgical approach for managing infected pancreatic necrosis?

    <p>Open necrosectomy or minimally invasive techniques like video-assisted retroperitoneal debridement</p> Signup and view all the answers

    What is the main goal of surgical management in cases of infected pancreatic necrosis?

    <p>To control infection and remove necrotic tissue</p> Signup and view all the answers

    Which of the following is considered an early complication of acute pancreatitis? A) Chronic pancreatitis B) Pancreatic abscess C) Acute respiratory distress syndrome (ARDS) D) Pseudocyst formation

    <p>Acute respiratory distress syndrome (ARDS)</p> Signup and view all the answers

    What is a common early complication that can occur within the first week of acute pancreatitis due to inflammatory processes?

    <p>Necrotizing pancreatitis</p> Signup and view all the answers

    Early complications of acute pancreatitis may include which of the following?

    <p>Pancreatic necrosis</p> Signup and view all the answers

    Which of the following is a late complication of acute pancreatitis? A) Hypocalcemia B) Pancreatic abscess C) Acute kidney injury D) Pseudocyst formation

    <p>Pseudocyst formation</p> Signup and view all the answers

    Late complications of pancreatitis typically arise after several weeks and can include:

    A) Hemorrhagic pancreatitis B) Pancreatic fistula C) Tachycardia D) Fever

    Which of the following is correct?

    <p>Pancreatic fistula</p> Signup and view all the answers

    What characterizes late complications of pancreatitis compared to early complications?

    <p>They are often due to complications arising from necrosis and inflammation.</p> Signup and view all the answers

    What is the average risk percentage of a second episode of pancreatitis due to gallstones after the first episode?

    <p>30%</p> Signup and view all the answers

    What is the recommended time frame for performing a cholecystectomy after an episode of acute gallstone pancreatitis?

    <p>6 weeks</p> Signup and view all the answers

    What percentage of patients diagnosed with pancreatic adenocarcinoma die within 12 months of diagnosis?

    <p>90%</p> Signup and view all the answers

    Which of the following is a common characteristic of pancreatic cancer regarding its prognosis?

    <p>Poor survival outcomes</p> Signup and view all the answers

    Which type of pancreatic cancer is most common and is associated with the statistics mentioned above?

    <p>Pancreatic adenocarcinoma</p> Signup and view all the answers

    According to Courvoisier's Law, what does a palpable, painless gallbladder in a jaundiced patient indicate?

    <p>Pancreatic cancer or other malignancies</p> Signup and view all the answers

    What is the significance of a palpable, painless gallbladder in the context of jaundice?

    <p>It raises suspicion for extrahepatic biliary obstruction due to a malignancy.</p> Signup and view all the answers

    If a patient presents with jaundice and a palpable gallbladder, which of the following conditions should be ruled out first?

    A) Cholecystitis B) Chronic liver disease C) Pancreatic cancer D) Biliary colic

    <p>Pancreatic cancer</p> Signup and view all the answers

    Which of the following findings would contradict Courvoisier's Law?

    <p>A jaundiced patient with a palpable, painless gallbladder</p> Signup and view all the answers

    In patients with Courvoisier's sign, which diagnostic test is most useful for determining the underlying cause of biliary obstruction?

    <p>Endoscopic retrograde cholangiopancreatography (ERCP)</p> Signup and view all the answers

    Which of the following is the most significant risk factor for developing pancreatic cancer?

    <p>Age</p> Signup and view all the answers

    What percentage of pancreatic cancer cases occurs in individuals aged 60 to 79 years?

    A) 50% B) 60% C) 70% D) 80%

    <p>80%</p> Signup and view all the answers

    Which lifestyle factor is associated with an increased risk of pancreatic cancer?

    <p>Smoking</p> Signup and view all the answers

    A patient presents with a history of chronic pancreatitis. What is this patient's risk of developing pancreatic cancer compared to the general population?

    <p>Significantly increased risk</p> Signup and view all the answers

    Which of the following is a common clinical feature of pancreatic cancer that indicates possible duodenal obstruction?

    <p>Vomiting</p> Signup and view all the answers

    What type of nodular finding might be seen in a patient with advanced pancreatic cancer?

    <p>Sister Mary Joseph nodule</p> Signup and view all the answers

    A patient with pancreatic cancer presents with back pain and weight loss. What is the likely cause of these symptoms?

    <p>Nerve invasion or irritation</p> Signup and view all the answers

    Which of the following symptoms is least likely to be associated with pancreatic cancer?

    <p>Fever</p> Signup and view all the answers

    Chronic pancreatitis can lead to which type of diabetes due to the destruction of insulin-producing cells?

    <p>Type 3 Diabetes</p> Signup and view all the answers

    Which of the following is a common symptom of malabsorption in patients with chronic pancreatitis?

    A) Polyuria B) Steatorrhea C) Weight gain D) Dehydration

    <p>Steatorrhea</p> Signup and view all the answers

    Which of the following dietary modifications is often recommended for patients with chronic pancreatitis to help manage diabetes and malabsorption?

    <p>Low-fat diet</p> Signup and view all the answers

    In chronic pancreatitis, the development of diabetes is primarily due to:

    <p>Impaired insulin secretion from pancreatic β-cells</p> Signup and view all the answers

    Which of the following is NOT a common risk factor for chronic pancreatitis?

    <p>High-fat diet</p> Signup and view all the answers

    What is the recommended approach for individuals with chronic pancreatitis related to alcohol consumption?

    A) Moderate drinking B) Complete abstinence C) Drinking only low-alcohol beverages D) Avoiding drinking on weekends

    <p>Complete abstinence</p> Signup and view all the answers

    What is the primary goal of palliation in the management of pancreatic cancer?

    <p>Alleviate symptoms and improve quality of life</p> Signup and view all the answers

    Which of the following is a common procedure used for relieving biliary obstruction in pancreatic cancer patients?

    <p>Biliary stent placement</p> Signup and view all the answers

    What additional procedure is typically performed during the Whipple procedure to address lymphatic spread?

    <p>Clearance of draining lymph nodes</p> Signup and view all the answers

    Which of the following statements about the Whipple procedure is TRUE? A) It is a curative surgery for all pancreatic cancer cases. B) It is only performed for patients with localized disease. C) It involves the removal of the entire pancreas. D) It is indicated for symptomatic relief only.

    <p>It is only performed for patients with localized disease.</p> Signup and view all the answers

    Signs of pancreatitis may include which of the following? (Select all that apply)

    <p>Epigastric tenderness</p> Signup and view all the answers

    Which of the following statements regarding chronic pancreatitis is true?

    <p>It may lead to diabetes mellitus due to endocrine dysfunction.</p> Signup and view all the answers

    Which of the following is a common complication of acute pancreatitis? (Select all that apply)

    <p>Both B and C</p> Signup and view all the answers

    Which of the following is a characteristic feature of necrotizing pancreatitis?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Pancreas Anatomy

    • Relevant anatomical details not specified in provided text.

    Acute Pancreatitis

    • Definition: Acute inflammation of the pancreas, releasing inflammatory cytokines and pancreatic enzymes. Affects all ages.
    • Mortality: 10% overall; accounts for 3% of hospital admissions with abdominal pain.
    • Causes: "I GET SMASHED" (Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypertriglyceridemia/Hypercalcemia, ERCP, Drugs). 80% of cases are idiopathic.

    Acute Pancreatitis: Pathogenesis

    • Autodigestive process: Pancreatic enzyme activation due to injury leads to tissue damage, cytokine release, and inflammatory response.

    Acute Pancreatitis: Symptoms

    • Epigastric pain (often rapid onset, radiating to the back, relieved by sitting forward).
    • Nausea and vomiting.

    Acute Pancreatitis: Signs

    • Depend on severity.
    • Can include dehydration, epigastric guarding, tachycardia, tachypnea, mild pyrexia.
    • Cholangitis (if present due to gallstones) may present with Charcot's triad (jaundice, pyrexia, RUQ pain).
    • Cullen's sign (periumbilical bruising) and Grey Turner's sign (flank bruising) indicate hemorrhagic pancreatitis.

    Acute Pancreatitis: Severity Stratification (Glasgow/Imrie Criteria)

    • Uses the mnemonic “PANCEA”: PaO2, Neutrophilia (WCC), Calcium, Enzymes (LDH, AST), Albumin.
    • Score >3 predicts severe disease, requiring high dependency/ICU care with hourly vital signs monitoring.

    Acute Pancreatitis: Workup

    • Bedside investigations (physical exam including vitals, CXR).
    • Laboratory investigations: Serum amylase/lipase, urinary amylase, FBC, CRP, LFTs, U&Es, LDH, calcium, albumin, glucose, urine dipstick, beta-hCG, coagulation profile, blood glucose, ABG/VBG (lactate).
    • Imaging: US abdomen (gallstones), CT pancreas (after 3 days to assess severity/complications; earlier if alternative diagnosis suspected).

    Acute Pancreatitis: Imaging - Ultrasound

    • Useful for identifying gallstones and, with an expert ultrasonologist, stones in the pancreatic duct.

    Acute Pancreatitis: CT Scan

    • Important but best delayed unless alternative diagnosis is suspected

    Acute Pancreatitis: Acute Management

    • Generally non-surgical. Includes oxygen, IV fluids (with urine output monitoring), analgesia, vital signs monitoring, Glasgow Imrie score assessment (repeated at 48 hours), management of systemic/local complications, feeding (when possible), antithrombotic prophylaxis, alcohol withdrawal management (chlordiazepoxide + pabrinex), and antibiotics for pancreatic necrosis (e.g., meropenem) with blood cultures.

    Acute Pancreatitis: Complications

    • ARDS, pseudocyst formation, pancreatic abscess, necrotizing pancreatitis, acute kidney injury, pancreatic hemorrhage, chronic pancreatitis, mortality, metabolic complications (hyperglycemia, hypocalcemia), and necrosis of the transverse colon.

    Necrotizing Pancreatitis

    • Two-phase disease: Weeks 1-2: severe SIRS due to cytokine release; Weeks 2+: sepsis-related complications due to infected pancreatic necrosis.

    Necrotizing Pancreatitis: Surgical Management

    • Severity assessment guides approach.
    • Infected necrosis requires operation, while sterile necrosis may be managed non-operatively. Glasgow criteria, C-reactive protein, APACHE II score, and dynamic CT inform decision-making.
    • Infected pancreatic necrosis accounts for 80% of acute pancreatitis-associated mortality.

    Preventing Further Episodes of Pancreatitis

    • Gallstones: 30% risk of recurrence (average 3 months post-attack); cholecystectomy usually done 6 weeks after acute gallstone pancreatitis. EUS/MRCP/ERCP may be indicated.
    • Alcohol withdrawal management.
    • Psychological and pharmacological support.
    • Treatment of hypercalcemia and hyperlipidemia.
    • Pancreatic neoplasms present with acute pancreatitis in 10% of cases.

    Chronic Pancreatitis: Pathogenesis

    • Protein precipitates in pancreatic tubules, with calcium deposition causing acinar obstruction. Leads to progressive pain (episodic or continuous), patchy fibrosis, and eventual exocrine and endocrine failure.

    Chronic Pancreatitis: Causes

    • Recurrent acute pancreatitis.
    • Pancreatic duct obstruction (tumors, cysts, strictures, congenital anomalies).
    • Cystic fibrosis.
    • Autoimmune diseases.
    • Idiopathic cases.

    Chronic Pancreatitis: Treatment

    • Addressing the causative agent (stopping alcohol, cholecystectomy, treating autoimmune diseases).
    • Dietary modifications (reduced fat).
    • Enzyme supplementation (e.g., Creon).
    • Analgesia.
    • Endoscopic therapy, celiac nerve block, or surgery (e.g., Whipple procedure) may be considered for intractable pain.

    Chronic Pancreatitis: Surgical Indication

    • Intractable pain is the most frequent indication for surgery.

    Pancreatic Cancer

    • Tumor doubling time is 60 days.
    • 85% of cases are unresectable.
    • Bypassed patients have a mean survival of 6 months.
    • 90% of patients with pancreatic adenocarcinoma die within 12 months.

    Courvoisier's Law

    • A palpable, painless gallbladder in a jaundiced patient is unlikely to be due to gallstones.

    Pancreatic Cancer: Risk Factors

    • Age (80% of cases in the 6th and 7th decades).
    • Smoking.
    • Alcoholism.
    • Diabetes.
    • Chronic pancreatitis.

    Pancreatic Cancer: Clinical Features

    • Progressive jaundice.
    • Vomiting (duodenal obstruction).
    • Ascites.
    • Back pain.
    • Anorexia.
    • Weight loss.
    • Sister Mary Joseph nodule.

    Pancreatic Cancer: Management

    • Palliation.
    • Biliary stent.
    • Surgery (Whipple procedure – resection of parts of the stomach, duodenum, pancreatic head and neck, gallbladder, and bile duct, with lymph node clearance).
    • Gastrojejunostomy.
    • Celiac axis block.

    Causes of Pancreatitis (Multiple Choice Question)

    • Alcohol (A), Autoimmune disease (B), Gallstones (E). Gastro-oesophageal reflux disease (C) and hypocalcaemia (D) are not listed as causes in the provided text.

    Signs of Pancreatitis (Multiple Choice Question)

    • Epigastric tenderness (A), Cullen's sign (B), dehydration (D). Courvoisier's law (C) and Murphy's sign (E) are not direct signs of pancreatitis, though relevant in diagnosis.

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    Explore the critical aspects of acute pancreatitis, including its definition, causes, pathogenesis, symptoms, and signs. This quiz will test your knowledge of the anatomical and physiological details related to this serious condition. Perfect for medical students and healthcare professionals.

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