Acute pancreatitis Flashcards
Pathophysiology
Autodigestion of pancreatic tissue by the pancreatic enzymes leaving to necrosis
Features
Severe epigastric pain radiating to the back
Associated vomiting
Abdominal tenderness
Systemically unwell
Signs
Cullen’s sign (periumbilical discolouration)
Grey Turner’s sign (flank discolouration)
Both rare
Investigations
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
Imaging
US is initial investigation of choice for assessing gallstones
CT abdomen can assess for complications
Glasgow score used for
Assessing severity
0-1 mild
2 moderate
> 3 severe
Glasgow score criteria
PaO2 <8
Age >55
Neutrophils (WCC >15)
Calcium <2
Urea >16
Enzymes (LDH >600 or AST/ALT >200)
Albumin <32
Sugar (glucose >10)
Key aspects of care
Fluid resuscitation- aggressive crystalloids
Analgesia
Not routinely NBM unless vomiting
Enteral offered if moderate/ severe within 72 hours presentation
Don’t offer antibiotics
Role of surgery
Gallstones- early cholecystectomy
Obstructed biliary system due to stones- ERCP
Infected necrosis- radiological drainage of surgical necrosectomy
Complications
Necrosis of the pancreas
Infection in necrotic area
Abscess formation
Acute peripancreatic fluid collections
Pseudocysts after 4 weeks
Chronic pancreatitis
Most common cause of chronic pancreatitis
Alcohol
Key complications of chronic pancreatitis
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
Management of chronic pancreatitis
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)
Pain in chronic pancreatitis
Typically worse 15-30 minutes following a meal