5. Diseases of Pancreas - Sakrani

• Common cause of acute pancreatitis

  • if pain on RUQ - it is secondary to gallstones
  • piercing pain in the back
  • history - due to alcohol
• Clinical features of acute pancreatitis

  • boring pain
  • located in epigastric or periumbilical
  • radiate to back
  • N/V
  • guarding or rebound tenderness - absent in early stages
• labs in acute pancreatitis

  • increase amylase
  • increase lipase
• Ranson's criteria - less than 3 is good
• When to do CT or US for acute pancreatitis?

  48 hrs, if pts still have symptoms
• chronic pancreatitis - inflammation and fibrosis with atrophy
• hallmark of chronic pancreatitis?

  steatorrhea
• Gold standard for chronic pancreatitis is?

  CT scan - see calcification, dilated ducts and atrophy
• if suspected with pancreatic steatorrhea

  • fecal elastase1 < 100 ug/gram of stool
• carcinoma of pancreas - most common is area?

  head
• pancreatic carcinoma - clinical features

  • jaundice due to obstruction
  • pruritis
  • palpable liver and gallbladder
  • back pain
• Courvoisier's law - palpable nontender gallbladder with jaundice unlikely to be due to gallstone
• avoid what in pancreatic cancer?

  percutaneous transperitoneal biopsy