18 - Pancreatitis Flashcards
2 mortality peaks for acute pancreatitis
w/in 1-2 wks from multi organ failure
later (3+wks) from infection
what starts the cascade of acute pancreatitis
conversion of typsinogen to trypsin > starts cascade of other enzymes and degrading the pancreas
cause of this first event usually unknown
pathophys of acute pancreatitis
initial insult is activation of enzymes
> microcirculatory damage > edema and ischemia
disruption of pancreatic ducts
cytokines from PMNs and macrophages > systemic inflammatory response
2 main causes of acute pancreatitis
gallstones (40%) and alcohol abuse (30%)
less common causes of acute pancreatitis
hyperTGemia
microlithiasis/biliary sludge
drugs
hypercalcemia
dx of acute pancreatitis
need 2 of:
typical sx
amylase/lipase 3x nl limits
CT findings of pancreatitis
acute pancreatitis sx and signs
sx: abd pain - epigastric radiating to back, steady, mod-severe; N/V
signs: abd tenderness
Gray Turner’s sign (ecchymoses in flanks)
Cullen’s sign - periumbilical ecchymosis
tachycardia, fever
resp distress, AMS in severe cases
which one rises quicker in acute pancreatitis - amylase or lipase?
amylase
imaging modality for pancreatitis
CT
Ranson’s criteria (not specfics, just general use)
for judging severity of acute pancreatitis
1 set for at admission, and check again at 48 hrs
Balthazar grades
CT scoring guide for acute pancreatitis
BISAP score
score for acute pancreatitis
BUN >25 Impaired mental status SIRS (>2 signs) Age >60 Pleural effusions
> 3 has likelihood for severe pancreatitis
management of acute pancreatitis
NPO (enteral feeding, not TPN)
aggressive IVF resuscitation (lactated ringer’s, maintain good urine output)
pain control (opiates)
*prophylactic abx generally NOT indicated
local complications of acute pancreatitis
pseudocysts, walled off necrosis
pathophys of chronic pancreatitis
loss of parenchymal cells, chronic inflammation, fibrosis
MCC chronic pancreatitis
alcohol abuse
presentation of chronic pancreatitis
abd pain exocrine insufficiency (steatorrhea, wt loss, diarrhea) endocrine insufficiency - usually later (DM, reduced glucagon)
indirect tests for chronic pancreatitis
fecal elastase
fecal fat
“gold standard” for chronic pancreatitis dx
ECRP - dialted pancreatic duct, filling defects, dilated side branches
mgmt of abd pain in chronic pancreatitis
stop ETOH
want to avoid pain meds if possible - addiction
pancreatic enzymes - non enteric coated
chronic pancreatitis and pancreatic adenoCA
4% lifetime risk of CA
inc w/ smoking
difficult to dx in setting of chronic pancreatitis - similar presentation
