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Z Year3 Gastro Conditions > Acute pancreatitis > Flashcards

Acute pancreatitis Flashcards

1
Q

What acronym is used for the causes of acute pancreatitis?

A

GET SMASHED

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2
Q

What are the causes of acute pancreatitis?

A 
Gallstones
Ethanol
Trauma 
Steroids
Mumps
Autoimmune 
Scorpion venom
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP and emboli
Drugs 
-Pregnancy, neoplasia or no cause found
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3
Q

What are the gastro symptoms and signs of acute pancreatitis?

A
  1. Gradual or sudden severe mid epigastric or central abdominal pain
  2. Radiating to back
  3. Sitting forward may relive
  4. Vomiting prominent and nausea
  5. Jaundice
  6. Rigid abdomen
  7. Cullen, Grey Turner sign
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4
Q

What are the general symptoms and signs of acute pancreatitis?

A
  1. Increase HR
  2. Fever
  3. Shock
  4. Signs of hypovoleamia
  5. Signs of pleural effusion
  6. Anoerexia
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5
Q

What are differential diagnosis for acute pancreatitis?

A
  1. Peptic ulcer disease
  2. Perforated viscus
  3. Oesophageal spasm
  4. Intestinal obstruction
  5. Abdominal aorta aneurysm
  6. Cholangitis
  7. Choledocholithiasis
  8. Cholecystitis
  9. Viral gastroenteritis
  10. Hepatitis
  11. Mesenteric ischaemia
  12. Myocardial infarction
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6
Q

What blood tests do you do for acute pancreatitis?

A
  1. Serum lipase and amylase
  2. FBC
  3. CRP
  4. Urea/creatine
  5. LFTs
  6. Serum calcium
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7
Q

What would serum lipase and amalyse be like in acute pancreatitis?

A

confirms if >3 times the upper limit of the normal range with acute upper abdominal pain

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8
Q

What is the fbc like in acute pancreatitis?

A
  1. leukocytosis

2. haematocrit >44% indicates poorer prognosis

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9
Q

What is CRP like in acute pancreatitis?

A

> 200 units/L pancreatic necrosis

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10
Q

What is urea and creatinine like in acute pancreatitis?

A

elevated

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11
Q

What are LFTs like in acute pancreatitis?

A

if >3 times the upper limit of normal, predicts gallstone disease as aetiology

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12
Q

What is serum calcium like in acute pancreatitis?

A

hypercalcaemia

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13
Q

What would pulse oximetry be like in acute pancreatitis?

A

hypoxaemia

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14
Q

What imaging is done for acute pancreatitis?

A
  1. CXR
  2. Transabdominal US
  3. AXR
  4. CT Scan
  5. ERCP
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15
Q

What would CXR show in acute pancreatitis?

A
  • atelectasis

- pleural effusion

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16
Q

What could US show in acute pancreatitis?

A
  1. confirms or excludes gallstones
  2. pancreatic inflammation
  3. peri-pancreatic stranding
  4. calcifications
  5. fluid collections
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17
Q

What would an AXR show in acute pancreatitis?

A

no psoas shadow

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18
Q

What would a CT scan show in acute pancreatitis?

A

assess severity and complications

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19
Q

What are the important factors to consider in management of acute pancreatitis?

A
  • Assess haemodynamic stability
  • Beware of SIRS
  • Arrange ERCP within 24hr
  • Nil by mouth
  • Repeat imaging to asses severity
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20
Q

What is the first line treatment for acute pancreatitis and gallstones with cholangitis?

A

fluid resuscitation

21
Q

What other things are needed in the treatment for acute pancreatitis and gallstones with cholangitis?

A
  1. analgesia
  2. Nutritional support, severity assessment
  3. ERCP
    - Consider: supplemental oxygen, antiemetic, IV antibiotics (if infection suspected), calcium and magnesium replacement therapy
22
Q

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

A

fluid resuscitation

23
Q

What else is needed in the management of gallstone pancreatitis without cholangitis or bile duct obstruction?

A
  1. analgesia
  2. Nutritional support, severity assessment
  3. Cholecystectomy
    - Consider: supplemental oxygen, antiemetic, IV antibiotics (if infection suspected), calcium and magnesium replacement therapy
24
Q

What is the first line treatment of gallstone pancreatitis with bile duct obstruction?

A

fluid resus

25
Q

What else is needed in the treatment of gallstone pancreatitis with bile duct obstruction?

A
  1. analgesia
  2. Nutritional support, severity assessment
  3. ERCP and sphiceteromty
    - Consider: supplemental oxygen, antiemetic, IV antibiotics (if infection suspected), calcium and magnesium replacement therapy
26
Q

What is the first line treatment for alcohol related pancreatitis?

A

fluid resus

27
Q

What are other things needed in the treatment of alcohol related pancreatitis?

A

First line: Fluid resuscitation

  1. analgesia
  2. Nutritional support, severity assessment
  3. Vitamin replacement + Alcohol abstinence programme
    - Consider: supplemental oxygen, antiemetic, IV antibiotics (if infection suspected), calcium and magnesium replacement therapy
28
Q

What is the first line treatment of ongoing acute pancreatitis deteriorating or failing to improve after 5-7 days?

29
Q

What else is needed in the management of ongoing acute pancreatitis deteriorating or failing to improve after 5-7 days?

A
  1. Ongoing supportive treatment
  2. Ongoing nutritional support
    - Consider: FNA and culture
30
Q

What is the first line treatment for infected pancreatic necrosis?

31
Q

What else is needed in the management of infected pancreatic necrosis?

A
  1. IV antibiotics

- Consider: catheter draining and necrosectomy/debridement

32
Q

What is the first line treatment of sterile pancreatic necrosis?

33
Q

What other things are needed in the management of sterile pancreatic necrosis?

A
  1. Ongoing supportive treatment
  2. Ongoing nutritional support
    - Consider: FNA and culture + catheter drainage or necrosectomy
34
Q

What are the possible complications of acute pancreatitis?

A
  1. Acute renal failure
  2. Pancreatic abscess
  3. Abdominal compartment syndrome
  4. Chronic pancreatitis
  5. Enteric fistulas
  6. Sepsis
  7. Acute lung injury / ARDS
  8. Pseudocyst
  9. Pancreatic ascites/pleural effusion
35
Q

What is the prognosis of acute pancreatitis?

A
  1. 80% with ap improve within 3 to 7 days of conservative management
  2. Mortality is 5% but rises to 30% in severe
36
Q

What drugs can cause acute pancreatitis?

A
  1. sodium valproate
  2. steroids
  3. thiazides
  4. azathioprine
37
Q

What is the defintion for acute pancreatitis?

A

reversible acute inflammation of pancreases

38
Q

What is the patho for acute pancreatitis?

A
  1. Calcium build up in inflamed pancreas
  2. Released of enzymes (amylase, lipase, protease)
  3. Enzymes damage local structures and cause systemic symptoms and signs
39
Q

What are the symptoms of hypovolaemia that may be present in acute pancreatitis?

A
  1. hypotension
  2. tachycardia
  3. sweating
  4. decreased skin turgor
40
Q

What signs are present in acute pancreatitis?

A
  1. Cullen’s – periumbilical brusing

2. Grey/Turners: flank brusing

41
Q

What is the preferred imaging for acute pancreatitis?

42
Q

What score is used for serverity of acute pancreatitis?

A

Modified Glasgow/PANCREAS SCORE

43
Q

What is involved in the PANCREAS socre?

A
  1. PaO2<8kPa(60mmHg)
  2. Age >55
  3. Neutrophils WBC >15x10^9/L
  4. Calcium <2mmol/L
  5. Renal function: Urea >16mmol/L
  6. Enzymes AST/ALT>200 iu/L or LDH >600iu/L
  7. Albumin <32g/l
  8. Sugar: glucose >10mmol/L
44
Q

What is the general Tx for acute pancreatitis?

A
  1. Analgesia
  2. IV fluids and electrolytes
  3. Oxygen support
  4. NG tube
  5. Control blood sugar
  6. ABx if infected necrotic tissue
45
Q

How do you treat gallstones if that is the cause of the AP?

A

ERCP (with sphincterotomy), cholecystectomy

46
Q

How do you treat necrotic tissue if that is the cause of the AP?

A

necresectomy

47
Q

How is ERCP peformed?

A
  1. to relieve biliary obstruction, with or without sphincterotomy (stent placement) to dilate the sphincter of Oddi
  2. allows ductal stones to be removed, biliary sludge to be cleared, and relief of the obstructed biliary tree driving pancreatitis
48
Q

What is the prognosis of acute pancreatitis?

A

20% of having Tx and still dying, haematocrit is a predictor of severity

Z Year3 Gastro Conditions (48 decks)

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