Acute pancreatitis Flashcards
what are the two most common causes of acute pancreatitis?
gallstones and alcohol misuse
where does the pain tend to localise in acute pancreatitis?
upper quadrant/epigastric sometimes radiates to flanks
what makes the pain worse in acute pancreatitis? What makes it better?
movement, alleviated by moving forward or assuming the foetal position
What sort of pain would be present if there are gallstones in acute pancreatitis?
knife-like sudden pain, worse after food
the character of pain in alcohol-induced acute pancreatitis?
less abrupt onset and poorly localised
what are the symptoms of acute pancreatitis besides upper abdominal pain?
nausea
vomiting
anorexia
fever
what is the name of ecchymosis around the umbilicus? Which disease does it implicate?
Cullen’s sign, acute pancreatitis
what is the name of ecchymosis around the flanks? Which disease does it implicate?
Grey turner’s sign, acute pancreatitis
which enzymes are increased in acute pancreatitis?
amylase
lipase
which enzyme is increased in gallstone causes of pancreatitis?
alanine transaminase (ALT) >150 U/L
what will the WBCC of someone with acute pancreatitis look like?
raised, especially neutrophils
what will happen to glucose and CRP in acute pancreatitis?
Increase
in acute pancreatitis, what are u&Es likely to show?
dehydration due to vomiting
what happens to calcium in acute pancreatitis?
hypocalcaemia
Which initial imaging would you do on a patient with acute pancreatitis?
USS
what would you look for on an abdominal x-ray in a patient with suspected acute pancreatitis and why?
sentinal loop sign - dilated proximal loop secondary to inflammation
what would you look for on a chest x-ray in a patient with suspected acute pancreatitis and why?
pleural effusion and signs of ARDS
what would you look for on a CT scan in a patient with suspected acute pancreatitis and why?
pancreatic oedema and swelling, non-enhancing necrosis
What are the glasgow criteria for pancreatitis?
PaO2 <8kPa Age >55 Neutrophils > 15x109/L Calcium <2mmol/L Renal function - urea >16mmol/L Enzymes - LDH >600iU/L AST >2000iU/L Albumin <32g/L Sugar - glucose >10mmol/L
What is the medical and supportive management for acute pancreatitis?
IV fluid resus + ABs Oxygen Analgesia Catheterisation Parenteral feeding if unable to tolerate oral intake
What is the surgical management for acute pancreatitis?
Percutaneous or endoscopic drainage of pancreatic collections
ERCP and cholecystectomy - gallstones cause
Surgical management of other complications eg. necrosectomy if necrotic tissue
What are the complications of acute pancreatitis?
Necrosis pseudocyst Abscess Fistulae Multi-organ failure Sepsis AKI ARDS Disseminated intravascular coagulation
