Acute Pancreatitis Flashcards
what are the common causes of acute pancreatitis?
- alcohol
- gallstones
what is the pathophysiology of acute pancreatitis?
- autodigestion of pancreatic tissue by pancreatic enzymes
- necrosis
what are the features of acute pancreatitis?
- severe epigastric pain that may radiate through to the back
- vomiting
what is seen on examination in acute pancreatitis?
- epigastric tenderness
- ileus
- low-grade fever
- cullen’s sign
- grey-turner’s sign
what is cullen’s sign?
periumbilical discolouration
‘got really drunk with edward cullen and he tried to do a body shot from your belly but he ended up biting you and you got a big bruise’ = periumbilical discolouration in acute pancreatitis
what is grey-turner’s sign?
flank discolouration
‘meridith GREY struts so much she gets bruising on her sides’ = flank discolouration
what investigations should be done in acute pancreatitis?
- serum amylase
- serum lipase
- imaging
what happens to serum amylase in acute pancreatitis?
- >3x the upper limit of normal
- does not correlate with disease severity
what are the causes for raised amylase?
- acute pancreatitis
- pancreatic pseudocyst
- mesenteric infarct
- perforated viscu
- acute cholecystitis
- diabetic ketoacidosis
when is serum lipase particularly useful in acute pancreatitis?
late presentation
longer half-life than amylase so useful in presentations >24 hours delayed
what imaging can be done in acute pancreatitis?
- early ultrasound - assess aetiology
- contrast-enhanced CT
what factors indicate severe pancreatitis?
- age >55 years
- hypocalcaemia
- hyperglycaemia
- hypoxia
- neutrophilia
- elevated LDH and AST
what is the most sensitive blood test for diagnosing acute pancreatitis?
serum lipase
how is severe acute pancreatitis classified?
persistent (>48 hours) organ failure
what is the key aspect of acute pancreatitis management?
fluid resuscitation
aggressive early hydration with crystalloids
what urine output should you aim for when managing acute pancreatitis?
> 0.5 mls/kg/hr
how is acute pancreatitis managed?
- fluid resuscitation
- analgesia
what analgesia is given in acute pancreatitis?
IV opioids
what nutrition advise should you give a patient with acute pancreatitis?
**enteral nutrition ** if moderate or severe acute pancreatitis within 72 hours of presentation
true or false
all acute pancreatitis should be nil-by mouth
false!
unless there is a clear reason e.g. vomiting
surgical management
acute pancreatitis due to gallstones
early cholecystectomy
surgical management
acute pancreatitis due to gallstones which has lead to an obstructed biliary system
early ERCP
surgical management
infected necrosis
radiological drainage or surgical necrosectomy
