Acute Pancreatitis Flashcards
What is acute pancreatitis?
Inflammation of the pancreas, usually caused by auto digestion.
What is autodigestion?
when the pancreatic enzymes are activated and digest the pancreas.
What exocrine functions does the pancreas have?
Exocrine - acinar cells secrete digestive enzymes secreted into the duodenum.
What endocrine function does the pancreas have?
alpha and beta cells secrete insulin and glucagon into the blood stream
What are symptoms of acute pancreatitis?
Intense epigastric pain (may radiate to the back) Hypocalcaemia nausea vomiting Cullens sign (bruising of belly button) Grey Turners sign (bruising of flank) Low grade fever Tachycardia Abdominal tenderness
What is the difference between acute and chronic pancreatitis?
Acute - Rapid onset inflammation and symptoms. After episode, normal function returns.
Chronic - Longer term inflammation with a progressive and permanent deterioration of pancreatic function.
What are the MAIN causes of acute pancreatitis?
Alcohol
Gallstones
What are the other causes of acute pancreatitis?
I GET SMASHED: Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hyercalcaemia + Hyperlipidaemia ERCP Drugs
which drugs commonly cause acute pancreatitis?
Furosemide (diuretic)
Azathioprine (immunosuppressant)
Thiazide diuretics
What investigations can be done?
Serum amylase erum Lipase Clinical signs CRP FBC U and Es LFT Calcium ABG Ultrasound (ultrasound)
What correlates to a positive diagnosis of acute pancreatitis?
Clinical signs + amylase or lipase >3x the upper limit of normal.
What signs suggest a more severe acute pancreatitis?
> 55yrs hypocalcaemia hyperglycaemia hypoxia neutrophilia Elevated LDH Elevated AST
Which enzyme is most specific to pancreatitis?
Lipase > amylase
How many people have increased serum amylase?
> 75% of people with acute pancreatitis.
The levels of amylase DO NOT correlate to the severity of the disease.
What must the amylase level be for pancreatitis?
Acute = >3x the upper limit of normal.
Chronic - amylase levels might not be increased since the pancreas ends up with reduced function.
Who is more likely to have alcohol induced acute pancreatitis?
Young Males
Who is more likely to have gallstone induced acute pancreatitis?
Women
Older patients
What score can be used to determine how severe the acute pancreatitis is?
Glasgow score
Mild = 0/1
Moderate = 2
Severe = 3 or over
What score can be used to determine how severe the acute pancreatitis is?
Glasgow score
Mild = 0/1
Moderate = 2
Severe = 3 or over
What is the management of acute pancreatitis?
IV fluids
NIL by mouth
Analgesia
When should antibiotics be given?
For necrosis or abscess
What is the treatment for gallstones?
ERCP
How long does acute pancreatitis usually take to get better?
3-7 days
What are the complications of acute pancreatitis?
Necrosis infection abscess DIC pseudocysts chronic pancreatitis
What are the signs of a pseudocyst?
can develop 4 weeks later
abdominal pain
loss of apetite
palpable mass
When should a CT abdomen be done?
Only when complications are suspected - pseudocyst, necrosis, fluid collection, abscess