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Year 3 Gastro > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What is a typical presentation for Acute pancreatitis?

A

Sudden-onset mid-epigastric or left upper quadrant abdominal pain

Often radiates to the back

Nausea and vomiting is seen in 80% of patients

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2
Q

What confirms diagnosis of acute pancreatitis?

A

Elevated serum lipase or amylase (>3x upper normal limit)

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3
Q

What are the most common causes of Acute pancreatitis?

A

Gallstones

Excessive alcohol consumption

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4
Q

What does initial acute pancreatitis treatment focus on?

A

Resuscitation w/ IV fluids
Analgesia
Nutritional support

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5
Q

What treatment may be employed in extreme cases?

A

Support for organ failure
Drainage of pancreatic necrosis
Ab therapy +/- surgical necrosectomy for infected necrosis

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6
Q

What is necrosectomy?

A

Removal of necrosed pancreas

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7
Q

Define acute pancreatitis?

A

A disorder of the exocrine pancreas, and is associated with acinar cell injury with local and systemic inflammatory responses

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8
Q

What are the key diagnostic factors in AP?

A

Upper abdo pain
Nausea and Vomiting
Hypovolaemia
Signs of Pleural Effusion

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9
Q

What is the most common presenting symptoms in AP?

A

Mid-epigastric or left upper quadrant pain that radiates to the back

Usually sudden onset, increasing in severity before plateuing

Stabbing pain

Worsens with movement

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10
Q

What might an abdo exam reveal in AP?

A

Tender and distended abdomen

Voluntary guarding to palpation of the upper abdomen

Diminished bowel sounds (if an ileus has developed)

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11
Q

What is important to remember about pain in AP?

A

Intensity and location of the abdominal pain do not correlate with severity

Minority of patients present without any abdominal pain

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12
Q

What can vomiting lead to?

A

Dehydration
Electrolyte abnormalities
Hypokalaemic metabolic alkalosis

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13
Q

What are signs of hypovolaemia?

A 
Hypotension
Oliguria
Dry mucous membranes
Decreased skin turgor
Sweating

Severe - tachycardic/tachypneic

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14
Q

What are signs of Pleural effusion?

A

Localised reduced air entry and dullness to percussion

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15
Q

What is anorexia secondary to in AP?

A

2ry to nausea, pain and general malaise

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16
Q

What are risk factors for AP?

A

Alcohol (esp. binge drinking)

Previous - gallstone disease, hypertriglyceridaemia, abdo trauma or invasive procedures

Azathioprine, mercaptopurine, didanosine

Recent infection e.g. EBV, mumps, mycoplasma

FH of pancreatitis

Middle aged women and young-middle men

17
Q

What is important to remember re AP and alcohol?

A

Do not assume that a patient’s acute pancreatitis is alcohol-related just because they drink alcohol

Unlikely unless over 6 units daily

18
Q

What are uncommon diagnostic factors in AP?

A 
Signs of organ dysfunction
Dyspnoea
Jaunidce
Signs of hypocalcaemia
Bruising
19
Q

What are the 1st investigations to order in AP?

A 
Serum lipase or amylase
FBS
CRP
Urea
Cr
Pulse Ox
LFTs
CXR
Transabdominal US
Serum calcium
20
Q

Which is preferred amylase or lipase?

A

Serum lipase
Lipase remains elevated for longer
Up to 14 days after onset of symptoms vs. 5 days for amylase

21
Q

What must you be careful about with lipase and amylase?

A

Sensitivity
1/4 have normal

Specificity
1/10 abnormal due to other condition

Pts with diabetes have higher median lipase levels

22
Q

What are you looking for in FBC in AP?

A

WCC raised
Leukocytosis with left shift (more immature WC)

Elevated haematocrit is a predictor of poor prognosis

23
Q

What does raised CRP indicate in AP?

A

CRP>200 units/L

indicated high risk of developing pancreatic necrosis

24
Q

What do LFTs tell you in AP?

A

Elevated ALT levels strongly suggest gallstones as the cause

In the absence of choledocholithiasis, LFTs are usually normal

25
Q

Why CXR in AP?

A

May identify possible causative factors and/or exclude other diagnoses

  • Pleural effusion
  • Basal atelectasis
  • Elevated hemidiaphragm
26
Q

Why serum calcium?

A

Hypercalcaemia, a rare cause of acute pancreatitis, may be identified.

27
Q

What investigations should be considered in AP?

A

Serum trigylcerides - (elevated can be uncommon cause >11.3mmol/L)

Abdo CT - in diagnostic doubt and where pts fail to improve within 48-72 hours.
Late phase > 1 week can identify local complications

EUS (endoscopic ultrasound) indicated when cause is idiopathic to exclude other causes

MRCP if CT is contraindicated. But preferred in choledocholithiasis

ABG - can be hypoxemic and need O2

28
Q

What are considered idiopathic causes of AP?

A

stones, biliary sludge, pancreatic divisum, and other abnormalities of the pancreatobiliary ducts

29
Q

What are emerging tests for AP?

A

Urinary trypsinogen-2

Serum IL-6 and IL-8

30
Q

What is treatment for gallstone pancreatitis with cholangitis?

A

Fluid resus

+analgesia (pain ladder)

consider sup. O2, antiemetic, IV Ab

+nutritional support

+severity assessment

consider Ca and Mg replacement

+ERCP

31
Q

What must be done in the first 48 hours with AP?

A

Use SIRS criteria for severity assessment

32
Q

What is treatment for gallstone pancreatitis without cholangitis or bile duct obstruction?

A

Fluid resus

+analgesia (pain ladder)

consider sup. O2, antiemetic, IV Abs

+nutrtional support

+severity assessment

consider Ca and Mg replacement

+cholecystectomy

33
Q

What is treatment for gallstone pancreatitis with a bile duct obstruction?

A

Fluid resus

+analgesia (pain ladder)

consider sup. O2, antiemetic, IV Ab

+nutritional support

+severity assessment

consider Ca and Mg replacement

+ERCP

34
Q

What is treatment for alcohol related pancreatitis?

A

Fluid resus

+analgesia (pain ladder)

consider sup. O2, antiemetic, IV Ab

+nutritional support

+severity assessment

consider Ca and Mg replacement

+vitamin replacement

+alcohol abstinence programme

35
Q

What is done if a pt deteriorates or fails to improve in 5-7 days?

A

CECT - contrast enhanced computed tomography

Ongoing supportive treatment

Ongoing nutritional support

Consider fine needle aspiration and culture

36
Q

What is the treatment for infected pancreatic necrosis?

A

CECT - contrast enhanced computed tomography

Ongoing supportive treatment

Ongoing nutritional support

Consider fine needle aspiration and culture

IV Abs

Consider catheter drainage

Consider necrosectomy/debridement

37
Q

What is the treatment for sterile pancreatic necrosis?

A

CECT - contrast enhanced computed tomography

Ongoing supportive treatment

Ongoing nutritional support

Consider fine needle aspiration and culture

Catheter drainage or necrosectomy

Year 3 Gastro (39 decks)

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