Acute Pancreatitis Flashcards
What is acute pancreatitis?
Acute inflammation of the pancreas
What are the 3 main causes of acute pancreatitis?
Post ERCP
Alcohol
Gallstones
What are the main presenting features of acute pancreatitis?
Severe epigastric pain tha radiates to the back
Vomiting
What are the main signs that can be seen in acute pancreatitis?
Cullen’s sign
Grey-Turner’s sign
What is Cullen’s sign?
Periumbilical discolouration
(bruising around the peri-umbilical area)
What is Grey-turner’s sign?
Flank discolouration
(bruising along the flanks)
What can be used to diagnose acute pancreatitis?
Serum amylase
What level should the amylase be to diagnose acute pancreatitis?
> 3 times the upper limit of normal
What does the level of amylase not tell you about acute pancreatitis?
The severity of the condition
What can be used to diagnose acute pancreatitis that is more sensitivie and specific than serum amylase?
Serum lipase
What is an advantage of serum lipase over serum amylase?
It may be useful for late presentations > 24 hours due to it’s longer half life
Can a diagnosis of acute pancreatitis be made without imaging?
Yes
If characteristic pain + amylase/lipase > 3 times normal level
Why is imaging useful in acute pancreatitis?
For the aetiology
What imaging is used first in someone with acute pancreatitis?
Ultrasound
(gallstones)
What can ERCP/MRCP be used to look for?
Obstructive pancreatitis
Why would you carry out a CT in someone presenting with acute pancreatitis?
To look for complications of pancreatitis
complications of pancreatitis
–Pseudocysts
–Necrotizing pancreatitis.
What can be used to diagnose the severity of acute pancreatitis?
Modified Glasgow Criteria
How can the modified glasgow criteria be remembered?
PANCREAS
What does PANCREAS stand for?
PaO2 < 8kPa (60mmHg)
Age > 55 years
Neutrophils - WBC >15 x109/l
Calcium < 2mmol/l
Renal function - Urea > 16mmol/l
Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L
Albumin < 32g/l
Sugar - Glucose >10mmol/L
What is the initial management of acute pancreatitis?
Aggressive fluid resuscitation with crystalloids
What should the urine output be kept above in someone presenting with acute pancreatitis?
> 30 mL/hour
What amount of fluid should you start a patient on?
Start with a 1 litre bolus and try to maintain adequate urine output. This usually amount to a fluid requirement of 3 – 5 ml/kg/hr
What else can be used in teh management of acute pancreatitis?
Analgesia- Opioids
Anti-ematics
When would you consider giving IV antibiotics to someone with acute pancreatitis?
If necrotising pancreatitis is present
When would you consider giving calcium to someone with acute pancreatitis?
If they are hypocalcaemic
Why might you need to give insulin to someone with acute pancreatitis?
Insulin may also be given in the presence of hyperglycaemia due to the damaged pancreas reducing release of the hormone.
What might cause Grey-Turners sign to occur?
Haemorrhagic pancreatitis,
What is a pneumonic for the drug causes of pancreatitis?
FATSHEEP
What does FATSHEEP stand for?
Furosemide
Azathioprine/Asparaginase
Thiazides/Tetracycline
Statins/Sulfonamides/Sodium Valproate
Hydrochlorothiazide
Estrogens
Ethanol
Protease inhibitors and NRTIs
What are the local complications of acute pancreatitis?
Peripancreatic fluid collections
Pseudocysts
Pancreatic necorsis
Pancreatic abscess
Haemorrhage
What is the systemic complication of acute pancreatitis?
Acute respiratory distress syndrome
What cna exaccerbate and alleviate the pain in acute pancreatitis?
Eating and lying down worsens the pain
Pain improves on leaning forward
