Acute pancreatitis Flashcards
GET SMASHED.
what is the G?
Gallstones
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what is the E?
ethanol
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what is the T?
trauma
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what is the 1st S?
steroids
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what is the M
mumps (coxsackie B)
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what is the A?
autoimmune
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what is the S?
scorpion
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what is the H?
-4
Hypertriglyceridaemia
Hyperchylomicronaemia Hypercalcaemia
Hypothermia
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what is the 2nd E?
ERCP
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what is the D?
-8
drugs
azathioprine mesalazine* didanosine bendroflumethiazide furosemide pentamidine steroids sodium valproate
which drugs used for UC is 7x more likely to cause acute pancreatitis than sulfasalazine?
mesalazine
how many cases are idiopathic?
give %
20%
how many cases are are mild to moderate?
give %
80%
how many cases are severe/life-threatening?
give %
20%
why is there fat necrosis?
lipase
why is there oedema?
inflammation makes BVs leaky
what causes destruction of pancreatic tissue?
proteolytic enzymes
how do gallstones cause acute pancreatitis?
- give step by step process
gallstone blocks duct, pressure increases and enzyme-rich fluid accumulates, ∴ lipase builds up –>fat necrosis –> this injured tissue trigger inflammation –> BVs leaky so oedema builds –> oedema further compromises blood flow –> ischaemia and even more injury.
how does alcohol case acute pancreatitis?
- 3
↑pancreatic exocrine secretion
↑contraction of the sphincter of Oddi
membrane damage.
what is the general pathophysiology of acute pancreatitis?
pancreatic enzymes auto-digest the pancreatic tissue (damage) –>
inflammation (more damage) makes BVs leaky –> fluid shifts –> oedema –> oedema compromises blood flow more –> ischaemia
symptoms of acute pancreatitis?
- 2 main ones
severe epigastric pain
vomiting is common
where does pain radiate to?
back
what is Cullen’s sign?
periumbilical discolouration
what is Grey-Turner’s sign?
flank discolouration
common signs?
-4
epigastric tenderness
ileus
low-grade fever
tachycardic
what will ileus sounds like on auscultation?
no bowel sounds
main bloods tests?
-2
which blood test is more specific for acute pancreatitis?
↑↑↑ Amylase
↑↑↑ Lipase
Lipase more specific
which imaging is 1st line to guide treatment by finding out the cause?
US
1st line immediate management?
- after abcde
- 2 things
IV fluids + opioids
what is the surgery for gallstone?
cholecystectomy
what is the surgery for Obstructed biliary system?
ERCP
what is the surgery for infected necrosis?
- 2
radiological drainage or necrosectomy
what is the surgery for Pseudocysts?
cystogastrostomy
what is the surgery for pancreatic abscess?
incise + drain
what can a pseudocyst complicate to?
abscess
what can peripancreatic fluid complicate to?
pseudocysts
through what mechanism/ what reason does giving fluids help with pain possibly?
helps lactic acidosis
what is the respiratory complication of acute pancreatitis?
Acute respiratory distress syndrome
what do you need to diagnose acute pancreatitis?
-2
high amylase/lipase + positive Hx
you want to check for gallstones quickly?
1st line Ix
US
