Acute Pancreatitis Flashcards
What is acute pancreatitis?
It is defined as a condition in which there is acute inflammation of the pancreas
What is the pathophysiological cause of acute pancreatitis?
This inflammation is due to enzyme-mediated autodigestion, caused by hypersecretion or an accumulation of exocrine digestive enzymes - amylase and lipase
This leads to necrosis of pancreatic tissue
What are the three classifications of acute pancreatitis?
Mild Acute Pancreatitis
Moderate Acute Pancreatitis
Severe Acute Pancreatitis
What is mild acute pancreatitis?
It is defined as pancreatitis associated with no organ dysfunction or complications
It resolves normally within a week
What is moderate acute pancreatitis?
It is defined as pancreatitis initially associated with some evidence of organ dysfunction
However, it improves within a period of 48 hours
What is severe acute pancreatitis?
It is defined as pancreatitis associated with persistent organ dysfunction, for a period greater than 48 hours, with local/systemic complications
What are the ten causes of acute pancreatitis?
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps/Malignancy
Autoimmune Disease, Alcohol
Scorpion Venom
Hypertriglyceridemia/Hypercalcaemia/Hyperchylomicronaemia/Hypothermia
ERCP
Drugs
What eight drugs are associated with acute pancreatitis?
Azathioprine
Mesalazine
Bendroflumethiazide
Furosemide
Sodium Valproate
Didanosine
Pentamidine
Corticosteroids
What are the two most common causes of acute pancreatitis?
Gallstones
Alcohol
What are the five risk factors for acute pancreatitis?
Male Gender
Older Age
Obesity
Alcoholism
Smoking
What are the eight clinical features associated with acute pancreatitis?
Sudden, Severe Epigastric Pain
Back Pain Radiation
Nausea & Vomiting
Appetitie Reduction
Abdominal Distension
Reduced Bowel Sounds
Cullen’s Sign
Grey Turner’s Sign
How is abdominal distension and reduced bowl sounds associated with acute pancreatitis?
In cases where there is an obstructive cause, ileus (bowel obstruction) can occur
What is Cullen’s sign?
It is defined as peri-umbilical bruising, due to intraperitoneal haemorrhage
What is Grey Turner’s sign?
It is defined as flank bruising, due to retroperitoneal haemorrhage
What are the four investigations used to diagnose acute pancreatitis?
Blood Tests
Ultrasound Scan
Chest X-Ray (CXR)
CT Scan
What two blood test results indicate acute pancreatitis?
Increased Serum Lipase Levels > 3x Normal Level
Increased Serum Amylase Levels > 3x Normal Level
Which blood test is first line in cases where patients present with suspected acute pancreatitis > 24 hours?
Lipase
This is due to the fact that serum lipase has a longer half life than amylase
What are the five other causes of raised amylase?
Pancreatic pseudocyst
Mesenteric infarct
Perforated viscus
Acute cholecystitis
Diabetic ketoacidosis
How are ultrasound scans used to diagnose acute pancreatitis?
They are the first line investigation used to identify causes of acute pancreatitis, such as gallstones and biliary obstruction
Why can ultrasound scans not be used to assess the pancreas?
This is due to the presence of bowel gas often obscuring the pancreas
What is the feature of acute pancreatitis on CXR?
Pneumoperitoneum
What is pneumoperitoneum?
It is free gas under the diaphragm
When are CT scans recommended to investigate acute pancreatitis?
They are conducted 48 – 72 hours after the initial presentation, in cases where patients don’t clinically improve
How are CT scans used to diagnose acute pancreatitis?
It is used to assess for other causes of severe abdominal pain and assess for complications of pancreatitis
What criteria is used to diagnose acute pancreatitis?
‘International Association of Pancreatology’
What does the ‘International Association of Pancreatology’ acute pancreatitis criteria state in terms of diagnosis?
It states that two of the three criteria must be met in order for a diagnosis of acute pancreatitis to be obtained…
Sudden, Severe Epigastric Pain
Serum Amylase/Lipase x3 Normal Levels
Imaging Findings Characteristic To Acute Pancreatitis
What two scoring systems are used to prognosticate acute pancreatitis?
Glasgow Imrie Score
Ranson’s Criteria
What is the Glasgow Imrie score?
It score is used to assess the severity of acute pancreatitis
What Glasgow Imrie score indicates severe acute pancreatitis?
> 3
What are the eight Glasgow Imrie score criteria?
PANCREAS
PaO2 < 7.9
Age > 65
Neutrophils > 15
Calcium < 2
Renal Function, Urea > 16
Enzymes, LDH > 600
Albumin < 32
Sugar > 10
What is Ranson’s criteria?
It is used to predict the mortality of acute pancreatitis
It uses a smaller range of clinical and biochemical markers; first at admission then again at 48 hours, to generate a predictive mortality score
What are the six poor prognostic criteria of acute pancreatitis?
Age > 55
Hypocalcaemia
Hyperglycaemia
Hypoxia
Neutrophilia
Increased LDH, AST Levels
Which blood test level is not used to predict prognosis of acute pancreatitis?
Acute amylase
What are the four immediate management options of acute pancreatitis?
IV Fluid Resuscitation
IV Analgesia (Paracetamol, Opioids)
Antiemetics
Blood Glucose Control
What IV analgesia is administered in acute pancreatitis?
IV Morphine 1-2mg boluses until comfortable
How do we nutritionally manage acute pancreatitis?
We allow individuals to eat orally as tolerated
What are the two management options for gallstone pancreatitis?
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Cholecystectomy
What is ERCP?
It is an endoscopic surgical procedure used to relieve biliary obstruction
What is cholecystectomy?
It is a surgical procedure that involves removal of the gallbladder
When is cholecystectomy recommended in gallstone pancreatitis?
It is recommended in all patients during the same admission as the acute episode
What are the three management options for alcohol induced pancreatitis?
Benzodiazepines
Anticonvulsants
Vitamin B12 Replacement
How are benzodiazepines used to treat alcohol induced pancreatitis?
They are the first line pharmacological option for treating alcohol withdrawal syndrome
Name two benzodiazepines used in acute pancreatitis
Chlordiazepoxide
Diazepam
How are anticonvulsants used to treat alcohol induced pancreatitis?
They are the second line pharmacological option for treating alcohol withdrawal syndrome
Name an anticonvulsant used to treat alcohol induced pancreatitis
Carbamazepine
How is vitamin B12 replacement used to treat alcohol induced pancreatitis?
It is recommended in individuals who present with Wernicke’s encephalopathy or Korsakoff’s syndrome
What thiamine replacement therapy is used in alcohol induced pancreatitis?
Intravenous high-dose Pabrinex
This should be followed by regular lower doses of oral thiamine
What are the seven complications of acute pancreatitis?
Necrotising Pancreatitis
Pancreatic Pseudocysts
Pancreatic Abscess
Pancreatic Insufficiency
Chronic Pancreatitis
Portal Vein/Splenic Thrombosis
Acute Respiratory Distress Syndrome (ARDS)
What is a pancreatic pseudocyst?
It is a cyst is surrounded in granulation tissue
This is in contrast to a true cyst which is surrounded with epithelial tissue
