Acute pancreatitis Flashcards

1
Q

What are the events leading to pancreatitis?

A

intrapancreatic activation of pancreatic enzymes -> destruction of pancreatic parenchyma -> attraction of inflammatory cells -> pancreatitis

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2
Q

What are the consequences of pancreatitis?

A
  • capillary leakage, hypotension, tachycardia -> DISTRIBUTIVE SHOCK
  • pancreatic necrosis
  • hypocalcemia -> lipase breaks down peripancreatic & mesenteric fat -> FATTY SAPONIFICATION
  • hemorrhage
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3
Q

What are the causes of pancreatitis?

A
  • gallstones
  • alcohol
  • post-ERCP
  • idiopathic
  • drugs
  • hypercalcaemia
  • pancreas divisum
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4
Q

What are the systemic complications of pancreatitis?

A
  • ileus
  • visual disturbances
  • confusion
  • irritability
  • encephalopathy
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5
Q

What are the metabolic complications of pancreatitis?

A
  • hypocalcemia
  • hyperglycemia
  • hyperlipidemia
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6
Q

What is the clinical presentation of a pancreatitis patient?

A
  • acute severe constant refractory EPIGASTRIC PAIN
  • radiates TO BACK
  • relieved by sitting or leaning forward
  • nausea
  • vomiting
  • retching
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7
Q

What will be seen upon physical examination of acute pancreatitis patient?

A
  • ill patient in severe pain
  • +- jaundice
  • normothermia -> if fever -> acute cholangitis
  • signs of shock -> tachycardia, tachypnea, hypotension
  • abdominal tenderness at epigastrium +- diffuse abdominal pain
  • guarding +- rigidity
  • Cullen’s sign
  • Grey Turner’s sign
  • Fox’s sign
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8
Q

What labs should be obtained to confirm acute pancreatitis?

A
  • Serum lipase +- amylase
  • CBC
  • CRP -> bad prognostic sign
  • electrolytes -> hypokalemic hypochloridemic metabolic alkalosis
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9
Q

What is Ranson’s Criteria for acute pancreatitis?

A

AT ADMISSION

  • > 55 years
  • WBC > 16000
  • glucose > 11mmol OR > 200mg
  • serum AST > 250
  • serum LDH > 350

AT 48 HOURS

  • serum calcium <2mmol OR <8mg
  • hematocrit fall > 10%
  • hypoxemia PaO2 < 60 mmg
  • BUN increased by 1.8mmol or more (5mg or more) after IV hydration
  • sequestration of fluids > 6L
  • if > or = 3: severe pancreatitis likely
  • if < 3: severe pancreatitis unlikely
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10
Q

What imaging techniques are used to diagnose acute pancreatitis?

A

ABDOMINAL US

  • pancreatic edema & swelling
  • gallstones
  • cholecystitis
  • dilated CBD

X ray

  • sentinel loop
  • colon cut-off

CT -> at 48-72 hours

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11
Q

What are the grades of pancreatitis according to Balthazar score?

A

A -> normal: 0
B -> enlarged: 1
C -> inflammatory changes in pancreas & peripancreatic fat: 2
D -> ill-defined single peripancreatic fluid collection: 3
E -> 2 or more poorly defined peripancreatic fluid collections: 4

A-C -> early
B & E -> severe

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12
Q

What investigations should be done for every pancreatitis case?

A

MRCP
ERCP
EUS -> in case of ampulla of Vater tumor

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13
Q

How is mild pancreatitis managed?

A
  • admission
  • analgesics
  • IV fluids
  • NPO
  • VTE prophylaxis
  • treat cause -> if gallstones -> cholecystectomy in same admission
  • continuous monitoring
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14
Q

How is severe pancreatitis managed?

A
  • IV RESUSCITATION
  • ICU admission
  • prophylactic antibiotic
  • VTE prophylaxis -> MAY cause hemorrhage
  • Foley’s catheter
  • intra abdominal pressure monitoring to prevent compartment syndrome
  • CVP
  • NGT if vomiting
  • NPO
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15
Q

What are the complications of acute pancreatitis?

A
  • acute peripancreatic fluid collection (APFC) -> resolves spontaneously (drainage only if symptomatic)
  • pseudocyst
  • pancreatic necrosis
  • pancreatic ascites
  • pancreatic pleural effusion -> drain
  • hemorrhage
  • portal or splenic vein thrombosis
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16
Q

What is the cause of a pseudocyst due to acute pancreatitis?

A
  • Mature APFC > 4 weeks from onset of pancreatitis
  • amylase rich fluid surrounded by well-defined wall of fibrous tissue
  • may communicate with main pancreatic duct
  • may lead to cystic/mucinous neoplasm of pancreas
17
Q

What is the treatment of a pseudocyst?

A
  • MRCP/ERCP ->determine communication with pancreatic duct +/- stent
  • resolves spontaneously -> if symptomatic -> transgastric drainage
18
Q

What should be done for pancreatic necrosis?

A

STERILE AT BEGINNING -> leave it alone
gradually could become walled-off necrosis
if INFECTED -> ATB, percutaneous drainage & culture -> no improvement -> pancreatic necrosectomy

19
Q

How is pancreatic ascites managed?

A
  • drainage
  • parenteral or nasojejunal nutrition
  • octreotide
  • ERCP for pancreatic duct stent

diagnosed by

  • paracentesis
  • amylase analysis
20
Q

How is hemorrhage due to acute pancreatitis treated?

A
  • resuscitation & stabilization
  • CT angiography + embolisation

bleeding into duodenum, peritoneum or retroperitoneum -> pseudoaneurysm

21
Q

How is portal & splenic vein thrombosis managed?

A
  • early systemic anticoagulation
  • aspirin for THROMBOCYTOSIS
  • management of portal hypertension manifestations