Acute and Chronic Pancreatitis Flashcards
What is acute pancreatitis?
Sudden inflammatory process with cascade release of inflammatory cytokines (TNF alpha, IL2, IL4) and pancreatic enzymes (trypsin/lipase ect)
Inflammation and auto-digestion leads to inflammation and haemorrhage of the pancreas
What are the causes of pancreatitis?
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Gallstones (60%, 2:1 cause UK) Ethanol (30%) Trauma (or Infection) Steroids, Mumps Autoimmune pancreatitis Scorpion sting, Hyperlipidemia (hypothermia, hyperparathyroidism) Endoscopic retrograde cholangiopancreatography (ERCP) Drugs
What are the clinical features of pancreatitis? (4)
- Severe epigastric pain, radiating to back
- Anorexia, nausea and vomitting
- Fever, dehydration, hyrotension, tachycardia (Septic Shock)
- Abdominal guarding
What are the classifications of pancreatitis? (3)
Oedematous (70%)
Severe/necotising (25%)
Haemorrhagic (5%)
What are the 3 scoring systems of pancreatitis?
Abbreviated glasgow scoring system
Ranson criteria
Balthazar score
(APACHE II may be used in intensive care)
What is the management of pancreatitis?
Analgesia! Catheterise ABCDE approach to resus/shock Drainage of collections may be required Antibiotics (ceftriaxone-metronidazole) Bowel rest Nutrition: NG/NJ feed and dietary supplements, potentially TPN IV infusion and fluid resuscitation
What drugs can cause pancreatitis?
Steroids
Azothioprine (DMARD)
Diuretics
NSAIDS
What signs are seen in hemorrhagic pancreatitis?
Grey-Turner’s signs (Left flank bruising)
Cullen’s signs (peri-umbilical bruising)
Pancreatitis is diagnosed on the basis of 2 out of 3 of what criteria?
- Characteristic severe epigastric pain radiating into back.
- Serum amylase of >1000U
- Abdominal CT scan pathology of pancreas
- Abnormality on abdominal x-ray (non-specific, CT more useful)
- USS may show gallstones
- Serum lipase (more specific)
What makes up the abbreviated glasgow scoring system?
8 clinical indicators, if >3 indicates need for ITU or anaesthetic review
PANCREAS
PaO2 <8kPa Age > 55 years Neutrophils > 15 x 10^9 Calcium < 2 mmol/l Raised urea > 15 mmol/l Elevated enzymes LDH or AST (levels) Albumin < 32g/l Serum glucose >15 mmol/l
What does the Ranson Criteria allow you to predict?
Risk of mortality
Scores taken at admission and at 48 hours
What does the Balthazar score use to grade?
Appearance of CT
Necrosis score
What are the potential complications of pancreatitis?
Systemic inflammatory response syndrome (SIRS)
(Pro-inflammatory state that doesn’t include a documented source of infection)
Haemorrhage and hypovolemic shock
Disseminated intravascular coagulation (DIC)
Multiple Organ Dysfunction Syndrome (MODS)
Acute respiratory distress syndrome
What is chronic pancreatitis?
Unknown mechanism causes activation of pancreatic enzymes leading to pancreatic tissue necrosis with eventual fibrosis.
(Abnormality of bicarbonate excretion)
Results in irreversible damage
What is the epidemiology of chronic pancreatitis?
Worldwide prevalence approx 4-5%
4:1 male:female
What changes are seen with alcohol consumption that leads to chronic pancreatitis?
Alcohol causes proteins to precipitate in the ductal structure of the pancreas, leading to dilatation and fibrosis.
No dose-response relationship, patients who drink a ‘normal’ amount can develop it.
What is the clinical presentation of chronic pancreatitis?
Severe abdominal pain, radiating to back.
Nausea and vomiting
Decreased appetitie
Exocrine dysfunction (malabsorption with weight loss, diarrhoea, steatorrhoea and protein deficiency)
Endocrine dysfuntion (diabetes mellitus)
What are the exocrine functions of the pancreas?
Releasing digestive enzymes
What is the endocrine function of the pancrease?
Releasing insulin and glucagon
What is autoimmune chronic pancreatits?
Chronic pancreatic inflammation resulting from an autoimmune process
High prevalence in Japan
What is a clinical identifier of autoimmune chronic pancreatitis?
Elevated levels of serum gammaglobulins and immunoglobulin G (IgG)
How can auto-immune chronic pancreatitis be treated?
Steroids
Where is the pancreas located?
Epigastric region behind the stomach
What cells secrete the exocrine enzymes and what do they secrete?
Acinar cells
Trypsinogen
Amylase (Starch)
Protease (Protein)
Lipase (Fat)
