Acute Pancreatitis Flashcards
What is acute pancreatitis?
Sudden onset inflammation of the pancreas and loss of function which resolves
What are the different patterns of lobule injury?
Periductal necrosis
Panlobular necrosis
Perilobular necrosis
Describe periductal necrosis
Necrosis of acinal cells adjacent to ducts
Due to duct obstruction
Describe panlobular necrosis
Necrosis of whole acinar lobule
Generally due to drugs/toxins/viruses/metabolic insults
Spread from periductal necrosis
Describe perilobular necrosis
Necrosis of the peripheries of lobules
Due to poor vascular perfusion
What are the potential early complications of pancreatitis?
Shock ARDS Renal failure DIC Hypocalcaemia Hyperglycaemia
What are the causes of acute pancreatitis
I GET SMASHED
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Bite Hyperlipidaemia, hypercalcaemia and hypothermia ERCP Drugs- azathioprine, diuretics, sodium valproate
What is the pathology underlying pancreatitis?
Original insult leads to activation of pancreatic enzymes within pancreatic cells leading to destruction and necrosis of pancreas causing inflammation
What are the Sx of acute pancreatitis?
Epigastric pain radiating to the back
Worse on lying down and relieved by sitting forwards
N&V
What are the signs of acute pancreatitis?
Tachycardia Fever Ileus Jaundice Rigid abdomen Cullen's sign Grey-Turner's sign
What is Cullen’s sign?
Periumbilical discolouration due to haemmorhage into peritoneal space
What is Grey-Turner’s sign?
Discolouration in flanks
What blood tests are appropriate when investigating suspected acute pancreatitis?
FBC U&Es LFTs CRP Amylase Lipase Ca Bilirubin ABG- for early resp failure
What imaging is appropriate when investigating suspected acute pancreatitis?
USS- look for gallstones
CT abdo for complications
CXR for perforation
ERCP- if concerned of obstruction to insert stent
What scoring systems can be used to predict the prognosis for acute pancreatitis?
Modified Glasgow Criteria
APACHE II
Ranson criteria
Describe the Modified Glasgow Criteria
- PaO2 <8kPa
- Age >55
- Neutrophils (WBC >15*10^9/L)
- Calcium <2mmol/L
- Renal urea >16mmol/L
- Enzymes (LDH >600iu/L, AST >200iu/L)
- Albumin <32g/L
- Sugar (glucose >10mmol/L)
Describe APACHE II
Allocates points for assessment of clinical parameters (A), age (B) and co-morbidities (C)
>9 indicates severe pancreatitis
Describe the Ranson criteria
Includes age + lab scores on admission + clinical findings at 48 hrs to give mortality risk
What are the potential late complications of acute pancreatitis?
Pancreatic pseudocyst Abscesses Bleeding (elastase eroding major vessel) Fistulae Thrombosis of splenic/gastroduodenal aa (bowel necrosis) Chronic pancreatitis
What is the immediate management of acute pancreatitis?
A-E resus IV fluid Catheterise Hrly monitoring - BP, pulse, urine output Daily bloods - FBC, U&Es, Ca, glucose, ABG Analgesia NBM- enteral nutrition only if indicated e.g. patient vomiting Stop alcohol Treat gallstones NG tube suction (if ileus/emesis) PPI (prevent stress ulcer) Anticoagulation Consider ITU admission Abx if infection
What additional management steps may be needed to treat the early complications of acute pancreatitis?
Antibiotics (severe cases) Laparotomy/debridement (abscess/pancreatic necrosis) Urgent ERCP (gallstones)
What is the prognosis of acute pancreatitis?
Unpredictable condition
- 85% settle w/i 3-7 days
- 15% require ICU admission (50% of these die)
What are the potential metabolic complications of acute pancreatitis?
Hyperglycaemia
Hypocalcaemia
Reduced serum albumin
Malabsorption (reduced vit levels)
How does the glasgow score determine severity of acute pancreatitis?
0-1 mild
2 moderate
>3 severe
What is chronic pancreatitis?
Where inflammation continues causing permanent damage to pancreas
What are the symptoms of chronic pancreatitis?
Chronic epigastric pain
Loss of endocrine and exocrine function
Increased incidence of pseudocysts and abscesses
What is the management of chronic pancreatitis?
CT scan with IV contrast to confirm diagnosis
Stop alcohol and smoking
Regular analgesia
Replacement of exocrine enzymes e.g. Creon
SC insulin
Surgery to treat abscesses
ERCP for stenting
