Acute Pancreatitis Flashcards
what is the definition of acute pancreatitis?
A disorder of the exocrine pancreas, and is associated with acinar cell injury with local and systemic inflammatory responses
what is the epidemiology of acute pancreatitis?
Incidence varies from 4.5 to 79.8 per 100,000 per year in different countries, with incidence in the UK reported at approximately 56 per 100,000 per year
In the UK, around 50% of cases are caused by gallstones, 25% by alcohol, and 25% by other factors
what is the aetiology of acute pancreatitis?
The most common causes are gallstones and excessive alcohol consumption
what are the risk factors for acute pancreatitis?
middle-aged women
young- to middle-aged men
gallstones
alcohol
what is the pathophysiology of acute pancreatitis?
Exact mechanism unknown
what are the key presentations of acute pancreatitis?
Typically presents with sudden-onset mid-epigastric or left upper quadrant abdominal pain, which often radiates to the back. Nausea and vomiting is seen in 80% of patients.signs of hypovolaemia
signs of pleural effusion
Anorexia
Presence of risk factors
what are the signs of acute pancreatitis?
signs of organ dysfunction dyspnoea jaundice signs of hypocalcaemia (Chvostek’s/Trousseau’s sign) (rare) Signs of hypocalcemia Signs of pleural effusion Anorexia Presence of risk factors
what are the symptoms of acute pancreatitis?
Upper abdo pain Nausea vomiting Dyspnoea Jaundice Ecchymotic bruising and discoloration
what are the first line and gold standard investigations for acute pancreatitis?
serum lipase or amylase - The diagnosis is confirmed in most patients by elevated serum lipase or amylase (>3 times upper limit of normal) FBC and differential C-reactive protein (CRP) urea/creatinine Pulse oximetry LFTs CXR Transabdo ultrasound Serum calcium
what other investigations could be done fo acute pancreatitis?
serum triglycerides
abdominal CT scan (CECT)
endoscopic ultrasound (EUS)
magnetic resonance cholangiopancreatography (MRCP)
what are the differential diagnoses of acute pancreatitis?
Peptic ulcer disease
Perforated viscus
Oesophageal spasm
how is acute pancreatitis managed?
Initial treatment focuses on resuscitation with intravenous fluids, analgesia, and nutritional support, with early oral feeding favoured if tolerated
In severe cases, treatment may include support for organ failure; drainage of pancreatic necrosis; and antibiotic therapy ± surgical necrosectomy for infected necrosis
how is acute pancreatitis monitored?
Long-term monitoring is not necessary. Patients usually resolve after their acute attack. If they modify their risk factors, another episode may not recur later in life
what are the complications of acute pancreatitis?
Acute renal failure, pancreatic abscess, abdominal compartment syndrome, chronic pancreatitis, enteric fistulas, sepsis, acute lung injury, pseudocyst
what is the prognosis of acute pancreatitis?
80% of cases are mild but in severe cases the mortality rate is as high as 30%. The pattern of deaths is biphasic, with early mortality (<2 weeks) related to systemic inflammatory response syndrome (SIRS)/multi-organ failure and later deaths (>2 weeks) due to local complications including infected necrosis
