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Gastrointestinal > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas

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2
Q

What are the 3 main causes of acute pancreatitis?

A

Post ERCP
Alcohol
Gallstones

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3
Q

What are the main presenting features of acute pancreatitis?

A

Severe epigastric pain tha radiates to the back
Vomiting

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4
Q

What are the main signs that can be seen in acute pancreatitis?

A

Cullen’s sign
Grey-Turner’s sign

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5
Q

What is Cullen’s sign?

A

Periumbilical discolouration
(bruising around the peri-umbilical area)

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6
Q

What is Grey-turner’s sign?

A

Flank discolouration
(bruising along the flanks)

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7
Q

What can be used to diagnose acute pancreatitis?

A

Serum amylase

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8
Q

What level should the amylase be to diagnose acute pancreatitis?

A

> 3 times the upper limit of normal

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9
Q

What does the level of amylase not tell you about acute pancreatitis?

A

The severity of the condition

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10
Q

What can be used to diagnose acute pancreatitis that is more sensitivie and specific than serum amylase?

A

Serum lipase

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11
Q

What is an advantage of serum lipase over serum amylase?

A

It may be useful for late presentations > 24 hours due to it’s longer half life

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12
Q

Can a diagnosis of acute pancreatitis be made without imaging?

A

Yes
If characteristic pain + amylase/lipase > 3 times normal level

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13
Q

Why is imaging useful in acute pancreatitis?

A

For the aetiology

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14
Q

What imaging is used first in someone with acute pancreatitis?

A

Ultrasound
(gallstones)

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15
Q

What can ERCP/MRCP be used to look for?

A

Obstructive pancreatitis

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16
Q

Why would you carry out a CT in someone presenting with acute pancreatitis?

A

To look for complications of pancreatitis
complications of pancreatitis
–Pseudocysts
–Necrotizing pancreatitis.

17
Q

What can be used to diagnose the severity of acute pancreatitis?

A

Modified Glasgow Criteria

18
Q

How can the modified glasgow criteria be remembered?

A

PANCREAS

19
Q

What does PANCREAS stand for?

A

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

20
Q

What is the initial management of acute pancreatitis?

A

Aggressive fluid resuscitation with crystalloids

21
Q

What should the urine output be kept above in someone presenting with acute pancreatitis?

A

> 30 mL/hour

22
Q

What amount of fluid should you start a patient on?

A

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

23
Q

What else can be used in teh management of acute pancreatitis?

A

Analgesia- Opioids
Anti-ematics

24
Q

When would you consider giving IV antibiotics to someone with acute pancreatitis?

A

If necrotising pancreatitis is present

25
Q

When would you consider giving calcium to someone with acute pancreatitis?

A

If they are hypocalcaemic

26
Q

Why might you need to give insulin to someone with acute pancreatitis?

A

Insulin may also be given in the presence of hyperglycaemia due to the damaged pancreas reducing release of the hormone.

27
Q

What might cause Grey-Turners sign to occur?

A

Haemorrhagic pancreatitis,

28
Q

What is a pneumonic for the drug causes of pancreatitis?

A

FATSHEEP

29
Q

What does FATSHEEP stand for?

A

Furosemide
Azathioprine/Asparaginase
Thiazides/Tetracycline
Statins/Sulfonamides/Sodium Valproate
Hydrochlorothiazide
Estrogens
Ethanol
Protease inhibitors and NRTIs

30
Q

What are the local complications of acute pancreatitis?

A

Peripancreatic fluid collections
Pseudocysts
Pancreatic necorsis
Pancreatic abscess
Haemorrhage

31
Q

What is the systemic complication of acute pancreatitis?

A

Acute respiratory distress syndrome

32
Q

What cna exaccerbate and alleviate the pain in acute pancreatitis?

A

Eating and lying down worsens the pain
Pain improves on leaning forward

Gastrointestinal (65 decks)

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