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Liver > Acute and Chronic Pancreatitis? > Flashcards

Acute and Chronic Pancreatitis? Flashcards

1
Q

What is pancreatitis?

A

Syndrome of inflammation of the pancreatic gland initiated by any acute injury. Difficult to differentiate between chronic and acute.

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2
Q

What are the three types of pancreatitis?

A
  1. Oedematous
  2. Necrotising
  3. Hemorrhagic
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3
Q

Briefly describe the pathophysiology of pancreatitis?

A
  • Premature activation of pancreatic enzymes cause pancreatic inflammation by autodigestion
  • These enzymes can also digest vessels leading to leakage into the tissues causing oedema, inflammation and hypovolaemia
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4
Q

What are the two causes of pancreatitis?

A
  • Alcohol

- Gallstones

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5
Q

How do gallstones cause pancreatitis?

A

Accumulation of enzyme rich fluid within the pancreas due to obstruction - intracellular Ca increased and causes early activation of trypsinogen

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6
Q

How does alcohol cause pancreatitis?

A

Alcohol interferes with Ca homeostasis and enzyme secretion is increased. There is also obstruction due to contraction of the ampulla of vater

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7
Q

What are the risk factors for pancreatitis?

A

I GET SMASHED

  • I - idiopathic
  • G - gallstones (majority - 80%)
  • E - ethanol (i.e. alcohol - 30%)
  • T - trauma
  • S - steroids
  • M - mumps
  • A - autoimmune
  • S - scorpion venom
  • H - hyperlipidaemia
  • E - ERCP (endoscopic retrograde cholangiopancreatography)
  • D - drugs (eg azathioprine, furosemide (diuretics), corticosteroids, NSAIDs, ACEIs)
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8
Q

What is the presentation of pancreatitis?

A
  • Severe epigastric or central abdominal pain that radiates to the back. (Relieved by sitting forward)
  • Anorexia, nausea and vomiting
  • Tachycardia
  • Fever
  • Jaundice
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9
Q

What are Cullen’s and Grey Turner’s sign?

A

Both skin discolouration due to blood under the skin due to bruising - a sign of severe necrotising pancreatitis
Cullen’s = Periumbilical
Grey Turner’s = Left flank

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10
Q

What are the main investigations you would perform in suspected pancreatitis?

A

Blood tests and abdominal ultrasound

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11
Q

What would you see in the blood test for someone with acute pancreatitis?

A
  • Raised serum amylase

- Raised serum lipase

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12
Q

What would you see on an abdominal ultrasound in pancreatitis?

A

Gallstone if gallstone cause

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13
Q

What factors are looked at in the Glasgow & Ransom scoring systems

A
  • PaO2
  • Age
  • Neutrophils
  • Calcium
  • Raised Urea
  • Elevated enzymes
  • Albumin
  • Sugar
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14
Q

How many factors in the Glasgow & Ransom scoring system need to be present to predict severe episode

A

3 or more factors present during the first 48 hours

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15
Q

What is the APACHE II score?

A

Acute physiology and chronic health evaluation - used to test severity and take into account chronic conditions

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16
Q

Give 3 complications of pancreatitis?

A
  • Hyperglycaemia
  • Hypocalcaemia
  • Renal failure
  • Shock
  • ARDS
  • DIC
  • Pseudocyst - fluid in lesser sac)
  • Thrombosis - may occur in the splenic/gastroduodenal arteries, or colic branches of the SMA, causing bowel necrosis
  • Fistulae - between pancreas and lungs
17
Q

What is systemic inflammatory response syndrome?

A

Any two of:

  • Tachycardia >90bpm
  • Tachypnoea >20 breaths pm
  • Pyrexia with temperature above 38
  • High WCC
18
Q

What is the management for acute pancreatitis?

A
  • Early fluids
  • Nothing by mouth
  • IV infusion
19
Q

What pharmacological treatments are given in acute pancreatitis?

A
  • Analgesia
  • Prophylactic antibiotics e.g beta-lactams
  • Insulin may be given if blood sugars need correcting
  • Supplemental O2 if rest complications
20
Q

What is chronic pancreatitis?

A

Irreversible fibrosis of the pancreas.

21
Q

What are the risk factors for chronic pancreatitis?

A
  • Alcohol
  • Smoking
  • Related to igG4 disease
22
Q

What is the presentation of chronic pancreatitis?

A
  • Severe abdo pain
  • Epigastric pain radiating to the back
  • Nausea and vomiting
  • Decreased appetite
  • Exocrine/endocrine dysfunction
23
Q

What are the complications of chronic pancreatitis?

A

Exocrine dysfunction = Malabsorption, weight loss, diarrhoea and steatorrhoea
Endocrine dysfunction = diabetes mellitus

24
Q

What is the treatment and management of acute pancreatitis?

A

Manage symptoms

  • Opiates/painkillers
  • Insulin
  • Nutrition

Liver (6 decks)

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