Acute pancreatitis Flashcards

1
Q

Pathophysiology

A

Autodigestion of pancreatic tissue by the pancreatic enzymes leaving to necrosis

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2
Q

Features

A

Severe epigastric pain radiating to the back

Associated vomiting

Abdominal tenderness

Systemically unwell

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3
Q

Signs

A

Cullen’s sign (periumbilical discolouration)

Grey Turner’s sign (flank discolouration)

Both rare

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4
Q

Investigations

A

FBC for WCC

U&Es for urea

LFT for transaminases and albumin

Calcium

ABG for PaO2 and blood glucose

Amylase raised x3 in acute

Lipase raised in acute

CRP

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5
Q

Imaging

A

US is initial investigation of choice for assessing gallstones

CT abdomen can assess for complications

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6
Q

Glasgow score used for

A

Assessing severity

0-1 mild

2 moderate

> 3 severe

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7
Q

Glasgow score criteria

A

PaO2 <8

Age >55

Neutrophils (WCC >15)

Calcium <2

Urea >16

Enzymes (LDH >600 or AST/ALT >200)

Albumin <32

Sugar (glucose >10)

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8
Q

Key aspects of care

A

Fluid resuscitation- aggressive crystalloids

Analgesia

Not routinely NBM unless vomiting

Enteral offered if moderate/ severe within 72 hours presentation

Don’t offer antibiotics

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9
Q

Role of surgery

A

Gallstones- early cholecystectomy

Obstructed biliary system due to stones- ERCP

Infected necrosis- radiological drainage of surgical necrosectomy

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10
Q

Complications

A

Necrosis of the pancreas

Infection in necrotic area

Abscess formation

Acute peripancreatic fluid collections

Pseudocysts after 4 weeks

Chronic pancreatitis

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11
Q

Most common cause of chronic pancreatitis

A

Alcohol

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12
Q

Key complications of chronic pancreatitis

A

Chronic epigastric pain

Loss of exocrine function (lack of pancreatic enzymes secreted into GI tract)

Loss of endocrine function (lack of insulin leading to diabetes)

Damage and strictures to the duct system resulting in obstruction

Formation of pseudocysts or abscesses

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13
Q

Management of chronic pancreatitis

A

Abstinence from alcohol and smoking

Analgesia

Creon (otherwise leads to malabsorption of fat, steatorrhoea and deficiency in fat soluble vitamins)

SC insulin

ERCP with stenting

Surgery (chronic pain, onstruction, pseudocysts, abscesses)

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14
Q

Pain in chronic pancreatitis

A

Typically worse 15-30 minutes following a meal

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