Where is the pancreas located?
Behind the stomach, next to the small intestine
What is the endocrine function of the pancreas?
- Insulin
- Glucagon
- Somatostatin
- Pancreatic polypeptide
What is the exocrine function of the pancreas?
- Amylase
- Proteases
- Lipases
What are the symptomatic consequences of an unwell pancreas?
- Diarrhoea
- Bloating
- Flatulence
- Oily and foul smelling stools
- Weight loss
- Malnutrition
- Poor blood sugar control
- Diabetes
What is acute pancreatitis?
Sudden inflammation of the pancreas
What are the causes of acute pancreatitis?
GET SMASHED
G - Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion venom
H - Hypertriglyceridaemia, Hyperchylomicronaemia
E - ERCP
D - Drugs
(azathioprine, mesealazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)Genetic - Cystic fibrosis and hereditary pancreatitis
What are the symptoms of pancreatitis?
- Sudden attacks
- Epigastric pain
- Radiates to the back
- Pain relieved by sitting forward / hot water bottles
- Nausea and vomiting
- Fever
- Tachycardia
What blood tests would you order and what would they show?
Amylase and lipase
- Elevated
What investigations would you order and what would they show?
- CT/MRI
Swollen pancreas
Abnormal fluid around pancreas
- ERCP
If duct blockage suspectedWhat is the treatment for acute pancreatitis?
- Nil by mouth
- Fluid resuscitation
Crystalloid
Monitor urine ouptu - Analgesia
- Supplemental O2
- Consider antiemetic
- Surgery if gallstones are the cause
What is the advice you would give to a patient with acute pancreatitis?
Avoid:
- Alcohol and tobacco
- High-fat foods
- Triglycerides
- Specific medication
How can you identify severe pancreatitis?
PANCREAS
P - PaO2 - <8kPa A - Age - >55yrs N - Neutrophillia – WBC >15 x 109/L C - Calcium - <2mmol/L R - Renal function- Urea >16 mmol/L E - Enzymes – LDH>600iu/L; AST>200iu/L A - Albumin - <32g/L (serum) S - Sugar – Blood glucose >10mmol/L
What is chronic pancreatitis?
Long-term inflammation of the pancreas which leads to irreversible damage of the pancreas
What are the symptoms of late chronic pancreatitis?
- Oily, foul smelling stools
- Weight loss
- Diabetes
- Recurring pain
What diagnostic test would you order for chronic pancreatitis?
- Blood glucose
- Abdo XR
Calcification - US +/- CT
Calcification - Endoscopic ultrasound
- Faecal elastase
Decreased
What is the treatment for chronic pancreatitis?
- No alcohol
- Smoking cessation
- Avoid high-fat foods
- Analgesia
- PERT (pancreatic enzyme replacement therapy)
- PPI
Omeprazole - Multivitamins and mineral supplements
What are the complications of chronic pancreatitis?
Type 3c diabetes
- Destruction of islet cells
What may you find on examination of a patient with acute pancreatitis?
- Tenderness, ileus and low-grade fever
- Cullen’s sign
Periumbilical discolouration - Grey-Turner’s sign
Flank discolouration
What are the complications of acute pancreatitis?
- Peripancreatic fluid collections
- Pseudocysts
- Pancreatic necrosis
- Pancreatic abscess
- Haemorrhage
