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Gastroentrology > 2: Acute Pancreatitis, Chronic Pancreatitis > Flashcards

2: Acute Pancreatitis, Chronic Pancreatitis Flashcards

1
Q

What is pancreatitis

A

Inflammation pancreas

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2
Q

How is acute pancreatitis differentiated from chronic pancreatitis

A

Acute pancreatitis disrupts secretory function of the pancreas with no structural changes.

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3
Q

How can the causes of acute pancreatitis be remembered

A

I.GET.SMASHED.

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4
Q

What are the causes of acute pancreatitis

A 
Idiopathic 
Gall stones 
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion
Hyperlipidaemia, hypothermia, hypercalcaemia
Ethanol
Drugs: NSAIDs, azathiopri ne
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5
Q

How does acute pancreatitis present clinically

A

Epigastric pain that radiates to the back. Improve on leaning forwards. Associated with nausea and vomiting.

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6
Q

How will severe pancreatitis present

A

Peritonism

Shock

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7
Q

What are two-signs of retroperitoneal haemorrhage

A

Cullens - peri-umbilical haemorrhage

Grey-Turner’s - haemorrhage of the flanks

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8
Q

Explain pathophysiology of pancreatitis

A

Pancreatitis causes pre-mature activation of digestive enzymes. If released into circulation degrade fats and blood vessels - can lead to retroperitoneal haemorrhage.

Inflammation in pancreatitis also causes vasodilation and third space losses of fluid which may result in dehydration.

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9
Q

What blood tests are ordered for pancreatitis

A

Serum amylase
Serum lipase
LFT

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10
Q

What serum amylase is indicative of pancreatitis

A

> 3 times upper limit of normal

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11
Q

What does an ALT >150 indicate

A

Gallstone pancreatitis

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12
Q

How will serum lipase present in pancreatitis

A

Raised.

It is more accurate for pancreatitis - however unavailable in some hospitals

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13
Q

What imaging may be ordered for acute pancreatitis

A

AUS

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14
Q

When is AUS ordered

A

Suspect gallstone pancreatitis

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15
Q

When is contrast enhanced CT performed

A

Unidentified pathology

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16
Q

What is time frame for performing contrast enhanced CT

17
Q

What scoring system is used in acute pancreatitis

18
Q

What is the glasgow scoring system

A

Used to predict severity of acute pancreatitis in 48h

19
Q

What does a Glasgow score >3 indicate

A

HDU referral

20
Q

What is the mnemonic to remember components of glasgow score

21
Q

What is the glasgow score components

A

PaO2 <8

Age >55

Neutrophils > 15

Calcium <2

Renal function. Urea: >16

Enzymes: LDH >600, AST >200

Albumin <32

Sugars >10

22
Q

Explain management of acute pancreatitis

A

Management is supportive, not curative. Underlying cause should be identified and addressed

23
Q

What is used to manage acute pancreatitis

A
  • Oxygen if required
  • Fluid resuscitation (Hartmanns)
  • NG tube if vomiting
  • Urinary catheter
  • Opioid analgesia
24
Q

What fluid is used in pancreatitis

A

Hartmann’s

25
Q

What are 5 complications of acute pancreatitis

A
  1. DIC
  2. ARDS
  3. Pancreatic necrosis
  4. Pancreatic pesudocyts
  5. Hyperglycaemia = as pancreas damaged - islets of langerhans release less insulin
  6. Hypocalcaemia
  7. Hypovolaemic shock
26
Q

What is chronic pancreatitis

A

Chronic fibre-inflammatory disease with progressive irreversible damage to paranchyma

27
Q

What gender does chronic pancreatitis affect more

A

Males (4:1)

28
Q

What age does chronic pancreatitis usually onset

29
Q

What is the main cause of chronic pancreatitis

A

Alcohol consumption (60%)

30
Q

What other factors can cause chronic pancreatitis

A 
Idiopathic 
Cystic Fibrosis 
Infective: mumps
Metabolic: hypercalcaemia
Autoimmune 
SLE
Neoplasm
31
Q

What are two risk factors for chronic pancreatitis

A

Smoking

Alcohol

32
Q

What are the symptoms of chronic pancreatitis

A
  • Chronic epigastric pain radiating to the back
  • May be associated with N+V

Endocrine dysfunction: DM

Exocrine dysfunction: Steatorrhoea, Weight loss

33
Q

What blood tests may be ordered in chronic pancreatitis

A

LFT
Glucose = raised: due to endocrine dysfunction
Bone profile = may be raised calcium (if cause)
Serum amylase/lipase = raised

34
Q

What is the main test to diagnose chronic pancreatitis

A

Faecal elastase level

35
Q

How will faecal elastase levels present in chronic pancreatitis

A

Abnormally low

36
Q

What imaging is ordered in chronic pancreatitis

37
Q

What is used to manage chronic pancreatitis

A

Analgesia

Insulin - endocrine dysfunction

Creon- pancreatic enzyme replacement

38
Q

What are 5 complications of chronic pancreatitis

A
  1. Malabsorption
  2. Diabetes
  3. Ascites
  4. Pseudocysts
  5. Malignancy

Gastroentrology (18 decks)

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