Acute & Chronic pancreatitis Flashcards
Cause
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids Mumps Autoimmune (PAN) Scorpion stings Hyperlipidaemia ERCP Drugs
ERCP is a dye infection (iatrogenic)
what is severe disease most commonly caused by
gallstones + alcohol
where do the pancreatic and bile ducts join?
at the ampulla of Vater
what pancreatic enzymes do the acinar cells produce?
lipase
colipase
amylase
proteases
difference between acute and chronic
acute - occurs in the background of a previously normal pancreas, and it returns to normal after the episode. Isolated + recurrent attacks. (25% develop severe acute)
chronic, continuing inflammation with irreversible structural changes
Pathogenesis acute pancreatitis
Elevated intracellular calcium
Cascade release of inflammatory cytokines + pancreatic enzymes
Acinar cell injury + necrosis
Inflammatory response
potentially –> SIRS
(single/multiple organ failure)
Classification of acute pancreatitis
oedematous
severe/necrotizing
haemorrhagic
Phlegmon
spreading inflammatory process with formation of pus abscesses
associated with oedematous
Pseudocyst
persistant pancreatic fluid collect which may eventually become infected
associated with severe/necrotising
presentation acute
severe epigastric pain –> back
nausea, anorexia + vomiting
fever, dehydration, hypotension, tachycardia - SEPTIC CHOCK
what signs in haemorrhagic? (acute)
Grey turner’s sign - bruising of the flanks
Cullen’s sign - bruising round the umbilicus
Diagnostic criteria acute
2 or 3 out of the following:
- severe epigastric pain–> back
- Serum amylase of >1000U (shouldn’t be used in isolation)
- Abd CT scan pathology e.g. loss of fat planes/pancreatic edema and swelling, fluid loculations (small compartments)
Tx acute
Analgesia (pethidine + tramadol) Catheterise O2, LMWH Antibiotics (ref/met) Bowel rest Nutrition (NG/IV) Fat soluble vitamins
Complications acute
SIRS MODS Pseudocyst Diabetes Biliary obstruction etc.
Scoring system acute
Glasgow
