**ACC (Y4)** Abdominal: Acute and Chronic Pancreatitis Flashcards
which region of the abdomen would you palpate the pancreas?
epigastric region
which cells of the pancreas secrete digestive enzymes?
acinar cells
what does the pancreas secrete to protect itself from its own digestive enzymes?
pro-enzymes or zymogens
what is acute pancreatitis?
characterized by distinct episodes of acute pancreatitis with full recovery between episodes
what is chronic pancreatitis?
Chronic pancreatitis is a chronic, irreversible, inflammation and/or fibrosis of the pancreas
what are the most common causes of acute pancreatitis?
gallstones or alcohol misuse
which type of people are infected more by pancreatitis? males or females?
Acute: males and females equally.
Chronic: males>females 4:1.
What are some risk factors of pancreatitis?
- Gall stones.
- Alcohol misuse.
- Endoscopic procesdures.
- Blunt abdominal trauma.
- Surgery near the pancreas.
- Metabolic conditions hypertriglyceridaemia and hypercalcaemia
- Infections such as mumps, coxsackie B4 virus, and Mycoplasma
pneumonia infection. - IBD.
- Smoking.
- Obesity.
- Family history.
how is mild acute pancreatitis characterised?
characterized by the absence of complications (local or systemic) or organ dysfunction. It usually has an uneventful recovery.
how is moderately severe pancreatitis characterised?
characterized by local complications and/or transient organ dysfunction which resolves within 48 hours.
how is severe pancreatitis characterised?
characterized by persistent organ dysfunction (failure to resolve in 48 hours) and often leads to local complications such as pancreatic necrosis, abscess, and pseudocyst formation.
What is the pain associated with pancreatitis described as?
- generalised abdominal pain
- pain may radiate to the back, may be relieved by sitting up/leaning forward
what may alleviate the pain associated with pancreatitis?
relieved by sitting up/leaning forward
what are some clinical features of pancreatitis?
- generalised abdominal pain which may radiate to the back
- nausea, vomiting
- bloating
- weight loss
- steatorrhoea
- jaundice
- signs of chronic liver disease
what is steatorrhoea?
the excretion of abnormal quantities of fat with the faeces owing to reduced absorption of fat by the intestine
how is the pain associated with pancreatitis different, if caused by gallstones?
- pain is sudden and knife like
- pain often starts after a large meal
how is the pain associated with pancreatitis different, if caused by alcohol?
- pain may be of less abrupt onset
- poorly localized
which conditions present in a similar way to acute pancreatitis?
- Perforated peptic ulcer, bowel obstruction, or ischaemic bowel.
- Ruptured abdominal aortic aneurysm.
- Myocardial infarction.
- Biliary colic, acute cholecystitis, or cholangitis.
- Viral hepatitis.
- Gastroenteritis.
which conditions present in a similar way to chronic pancreatitis?
- Acute cholecystitis, biliary colic.
- Acute pancreatitis.
- Irritable bowel syndrome.
- Peptic ulcer disease.
- Post-herpetic neuralgia.
- Gastroparesis.
- Internal obstruction, ischaemia or infarction.
- Abdominal aortic aneurysm.
- Thoracic radiculopathy.
- Myocardial infarction.
what may make the pain associated with pancreatitis worse?
movement (that’s not the fetal position)
what should you examine for when presented with suspected pancreatitis?
- Abdominal tenderness.
- Abdominal distension.
- A bluish discolouration around the umbilicus
(Cullen’s sign); or the flank (Grey-Turner’s sign) is sometimes associated with haemorrhagic pancreatitis (a late, serious complication). - Tachycardia and hypotension — caused by shock.
what is Cullen’s sign?
A bluish discolouration around the umbilicus associated with haemorrhagic pancreatitis
what is Grey Turner’s sign?
A bluish discolouration around the flank of abdomen associated with haemorrhagic pancreatitis
What investigations will be carried out in secondary care for pancreatitis?
- Blood tests to look for elevated levels of pancreatic enzymes (lipase or amylase levels).
- Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas
inflammation. - Abdominal ultrasound to look for gallstones and pancreas inflammation.
- Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct.
- Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts.
- Stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn’t
absorbing nutrients adequately.
What is the treatment for pancreatitis?
admit patient urgently is suspected pancreatitis
- IV fluids
- Oxygen supplements
- Pain relief
- Antibiotics for associated cholangitis or infection
- Nutritional support
what are some local complications of acute pancreatitis?
- Pancreatic necrosis (necrotizing pancreatitis) with or without infection.
- Pseudocyst which can be complicated by infection, rupture or haemorrhage.
- Pancreatic abscess.
- Fistulae.
- Vascular complications e.g. pre-hepatic portal
hypertension, erosion of a pancreatic, splenic or peri- pancreatic artery or vein with haemorrhage.
what are some systemic complications of acute pancreatitis?
- Acute renal failure.
- Multiple organ dysfunction.
- Acute respiratory distress syndrome.
- Disseminated intravascular coagulation.
- Sepsis.
what are some common complications of chronic pancreatitis?
- Maldigestion and malabsorption (malnutrition).
- Diabetes mellitus.
- Chronic pain.
- Opioid dependency for treatment of chronic pain.
- Low-trauma fracture due to an increased risk of osteoporosis due to malabsorption.
- Pancreatic calcification.
- Pseudocyst formation.
