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20 Cards in this Set
- Front
- Back
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Etiology of chronic pancreatitis?
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alcohol 60-80%
obstruction of bilary duct 25% cystic fibrosis (possible without other manifestations) pancreas divisum |
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Most sensitive and specific test for pancreatic exocrine function?
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faecal elastase
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Clinical features of chronic pancreatitis?
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* sx like acute pancreatitis but episodic or chronic unremitting
* may present with endo/exocrine failure alone (DM, malabsorption) * jaundice (fibrosed head of pancreas) |
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tests for chronic pancreatitis?
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faecal elastase
MRCP/ERCP |
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Rx for chronic pancreatitis
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pain: opiates, amytriptyline, enzyme supplements
steatorrhoe: enzyme supplements, H2 blocker/PPI diabets: difficult - insulin in most cases needed. |
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Most common complication of chronic pancreatitis?
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* pseudocysts
* ascites/pleural effusion |
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How to manage pseudocysts?
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spontaneous resolution if <6cm
if larger and persistent for >6 weeks may require endoscopic drainage (through stomach; most cysts lie directly posterior to posterior stomach wall). success rate 75% laparotomy if failure or cysts not accessible |
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What is the relevance of ascites/pleural effusions in chronic pancreatitis?
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rupture of pancreatic duct
require surgery. |
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Suspicion of neuroendocrine pancreatic tumor - which test?
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chromogranin A in 80%
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imaging for neuroendocrine tumors of the pancreas?
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* endoscopic USS
* radiolabled octreotide scan |
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Dx of gastrinoma?
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gastrin level
gastric pH low |
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how does a VIPoma present?
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* severe secretory diarrhoe
* hypokalaemia * metabolic acidosis |
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how does a glucagonoma present?
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* migratory necrolytic dermatitis
* diabetes * DVT * anaemia, hypoalbuminaemia |
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Screening test for porphyria?
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urinary porphyrins
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what are the acute porphyrias?
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acute intermittent porphyria (AIP)
variegate porphyrua (VP) hereditary coproporphyria (HCP) |
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DDx of three acute porphyrias?
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VP - plasma porphyrins are much increased (not in HCP or VP)
HCP and VP - faecal porphyrins raised (not in AIP) |
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What is Familial Mediterranean Fever?
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autosomal recessive disorder with sporadic attacks of fever and serosal inflammation
defect for pyrin on Chromosome 16 |
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Clinical features?
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fever and 75% serositis (arthritis, peritonitis, pleuritis)
arthritis is monoarthritis constipation followed by diarrhoe is common |
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Diagnosis of FMF?
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genetic test
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Tests for gastrinoma?
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serum gastrin level >1000
secretase stimulation test (gastrin level higher after stimulation) to differentiate low output gastrinomas from other causes |
