abdominal pain and pancretitis Flashcards

1
Q

Define acute and chronic pancreatitis.

A

Acute pancreatitis - endocrine/exocrine function of the pancreas and its structure returns to normal after he episode of pancreatitis

Chronic pancreatitis - permanent structural changes occur and pancreatic function is permanently damaged

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2
Q

Recall the causes of acute pancreatitis.

A

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune

Scorpion Venom

Hyperlipidaemia/Hypercalcaemia

ERCP

Drugs

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3
Q

State some symptoms and signs of acute pancreatitis. Name the specific signs.

A

Epigastric pain radiating to the back

Nausea and vomiting

Patient acutely unwell and in shock

May have organ failure

May be evidence of jaundice/cholangitis

Grey Turner’s Sign - ecchymoses on the flanks (lateral abdominal wall)

Cullen’s Sign - ecchymoses below the umbilicus

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4
Q

List some blood tests and imaging modalities that are useful for patients with pancreatitis.

A

Elevated pancreatic enzymes (amylase/lipase)

Lipase remains elevated longer and is more specific of pancreatitis but it isn’t normally measured

Radiological: Chest X-ray to eliminate possibility of perforated ulcer

Abdominal X-ray - eliminate the possibility of local ileus

CT - if there is any diagnostic doubt

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5
Q

Recall three causes of chronic pancreatitis.

A

Alcohol excess

Microlithiasis

Idiopathic

Rarer causes: hereditary, hyperparathyroidism

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6
Q

What would you expect the amylase and lipase levels of a patient with chronic pancreatitis to be and why?

A

Normal - due to loss of pancreatic enzyme function

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7
Q

Recall the complications of acute and chronic pancreatitis.

A

Systemic:

Hypovolaemia (dehydration)

Hypoxia (unable to breathe deeply because of upper quadrant pain)

Hypocalcaemia

Hyperglycaemia

DIC

Multiple Organ Failure

Local:

Pancreatic necrosis

Fluid collections - mature into pseudocysts

Splenic vein thrombosis/pseudoaneurysm

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8
Q

What is the vertebral level of the pancreas?

A

L1/L2

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9
Q

Acute and chronic pancreatitis can be further classified on the basis of what?

A

Aetiology

Pathology

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10
Q

At what level does pancreatic amylase have to be to be diagnostic of pancreatitis?

A

3 x upper border of normal

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11
Q

Name three scoring systems used for pancreatitis.

A

Modified Glasgow Scale

Ranson Scale

Apache II

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12
Q

How would you treat the complications of someone with acute pancreatitis?

A

Rehydrate

Interventional radiology - embolisation of haemorrhage and drainage of abscess

Surgical - cholecystectomy, necrosectomy, drainage of pseudocyst

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