acute pancreatitis Flashcards
where is the
pancreas located ?
in the epigastric region of the abdomen, as part of the retroperitoneal space
what are the 4 parts of the pancreas ?
head, neck, body and tail
characteristics of the : head
C shaped cavity (created by the duodenum)
has a small ulcinate process which hooks upwards behind the SMA and the SMV
: neck
connects the head to the body
behind the neck is where the portal vein forms into the splenic and SMVs
: body
runs upwards and to the left across the midline
: tail
travels with the splenic vessels between the layers of splenorenal ligament, to reach the hilum of the spleen
which part of the pancreas secretes pancreatic juice ?
exocrine - via the acinar and duct cells
what part of the pancreas secretes glucagon and insulin ?
endocrine - via islets of langerhans
what causes acute pancreatitis ?
inflammation - due to either hypersecretion or backflow (due to obstruction) of exocrine digestive enzymes > resulting in the auto-digestion of the pancreas
= GALLSTONES, DRUGS (steroids) and ALCOHOL are the main causes
what are the two major categories of pancreatic damage ?
- interstitial oedematous pancreatitis
- necrotising pancreatitis
which type of pancreatitis is irreversible ?
chronic
IGETSMASHED
Idiopathic Gallstones Ethanol Trauma Steroids Mumps/Malignancy Autoimmune disease Scorpion sting Hypertriglyceridemia/hypercalcaemia ERCP Drugs - azathioprine, thiazides, paracetamol
what are the risk factors for acute pancreatitis ?
male gender
old
obese
smoker
symptoms & history
> epigastric pain - severe, sudden onset, and may radiate to the back
nausea / vomiting
decreased appetite
anorexia
- PMH of gallstones, biliary disease, previous pancreatitis
- past surgical history (ERCP)
- drug history (azathioprine)
- social history (alcohol and smoking)
- family history
clinical findings
- epigastric tenderness
- abdominal distention
- reduced bowel sounds (ileus)
- systemic inflammatory response
these are late signs of severe intra-abdominal and retroperitoneal haemorrhage
-Cullen’s Sign (periumbilical bruising)
-Grey Turner’s (flank bruising)
what criteria can be used for acute pancreatitis ?
Atlanta Criteria :
mild = most common, no organ dysfunction, resolves within the week moderate = some evidence of organ failure which improves within 2 days severe = persistent organ dysfunction for more than 48hours with local or systemic complications
what are the three main criteria to diagnose acute pancreatitis ?
- abdominal pain plus a suggestive history
- serum amylase/lipase 3x normal
- imagine findings of acute pancreatitis
(need 2/3 to confirm)
investigations
> ECG - rule out MI
> urinalysis - routine for acute abdominal pain
>lab: FBC - anaemia and raised WCC CRP LFTs Lipase - raised (normal is 15-60U/L) Serum amylase - raised VBG ABG - essential for prognosis beta-hCG - rule out pregnancy
> imaging:
CXR - will see free gas
Abdominal US
CTAP (abdomen and pelvis)
what is the prognostic tool for severity of acute pancreatitis ?
glasgow-imrie score
----------------------- PANCREAS P-PaO2 <7.9 Age >55 Neutrophils >15 Calcium <2.0 Renal function : urea >16mmol/L Enzymes : LDH > 600 Albumin <32g/L Sugar > 10mmol
management (immediate)
>ABCDE >IV resuscitation and correction of electrolyte disturbances >analgesia >antiemetics >nothing to be taken orally >control of blood glucose
management (nutrition)
NBM (nil by mouth) until pain improves
management (specific)
for:
gallstone pancreatitis -
>ERCP to relieve obstruction, this can be done with or without a sphincterotomy (dilate the sphincter of Oddi)
>cholecystectomy - removal of the gall bladder
alcohol-induced pancreatitis -
>withdrawing from alcohol = benzodiazepines, thiamine, folate and vit B12 replacement
complications
- chronic pancreatitis
- portal vein/splenic thrombosis
- pancreatic pseudocysts
