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20 Cards in this Set

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