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YR6: GASTRO > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammatory condition of the pancreas

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2
Q

Describe the classification of acute pancreatitis

A

Mild: minimal organ dysfunction + uneventful recovery
Severe: organ failure +/or local complications such as necrosis, abscesses + pseudocysts

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3
Q

Describe the sequence of events in the pathophysiology of pancreatitis

A
  1. Intrapancreatic activation of pancreatic pro-enzymes: secondary to pancreatic ductal outflow obstruction or direct injury to pancreatic acinar cells
  2. Increased proteolytic + lipolytic enzyme activity → destruction of pancreatic parenchyma
  3. Attraction of inflammatory cells (neutrophils, macrophages) → release of inflammatory cytokines → pancreatic inflammation (pancreatitis)
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4
Q

List 3 potential sequelae of pancreatitis

A

Capillary leakage
Pancreatic necrosis
Hypocalcaemia

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5
Q

Name 2 causes of direct injury to pancreatic acinar cells

A

Alcohol
Drugs

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6
Q

Name 2 causes of pancreatic ductal outflow obstruction

A

Gallstones
Cystic fibrosis

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7
Q

Describe what results from capillary leakage secondary to acute pancreatitis

A

Release of inflammatory cytokines + vascular injury by pancreatic enzymes
→ vasodilation + increased vascular permeability
→ shift of fluid from intravascular space into interstitial space (third-space fluid loss)
→ hypotension, tachycardia, warm + flushed skin
→ distributive shock

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8
Q

Describe how pancreatic necrosis can arise secondary to acute pancreatitis

A

Uncorrected hypotension + third-spacing
→ decreased end-organ perfusion
→ multiorgan dysfunction (mainly renal) + pancreatic necrosis

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9
Q

Describe how acute pancreatitis can lead to hypocalcaemia

A

Lipase breaks down peripancreatic + mesenteric fat
→ release of free fatty acids that bind calcium
→ hypocalcemia (fatty saponification)

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10
Q

What are the 3 most common causes of acute pancreatitis?

A

Gallstones
Alcohol
Idiopathic

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11
Q

What are the conventional causes of pancreatitis?

A 
Idiopathic
Gallstones  
Ethanol 
Trauma 
Steroids 
Mumps/ HIV/ Coxsackie 
Autoimmune 
Scorpion Venom 
Hypercalcaemia/ hyperlipidaemia/ hypothermia 
ERCP 
Drugs (e.g. sodium valproate, thiazides + azathioprine)
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12
Q

List 8 drugs that can cause acute pancreatitis

A

Azathioprine
Mesalazine
Didanosine
Bendroflumethiazide
Furosemide
Pentamidine
Steroids
Sodium valproate

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13
Q

Summarise the epidemiology of pancreatitis

A 
COMMON 
UK Annual Incidence: 10/10,000 
Peak age: 60 yrs  
Most common cause in: 
Young Males = alcohol  
Middle age Females = gallstones
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14
Q

List 3 symptoms of acute pancreatitis

A

Constant severe epigastric pain
N+V
Fever

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15
Q

Describe the pain in acute pancreatitis

A

Classically radiating towards the back
Worse after meals, when supine + on movement
Relieved by sitting forward

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16
Q

List 5 general signs of pancreatitis on physical examination

A

Shock
Tachycardia
Hypotension
Oliguria/ Anuria
+/- Jaundice (in biliary pancreatitis)

17
Q

List 4 signs found on abdominal examination in acute pancreatitis

A

Abdominal tenderness, distension + guarding
Ileus with reduced bowel sounds + tympani on percussion
Ascites
Skin changes (rare)

18
Q

What causes ileus in acute pancreatitis?

A

Inflammation

19
Q

What pulmonary S/S may be present in acute pancreatitis?

A

Chest pain + dyspnea
Signs of pleural effusion +/or ARDS

20
Q

Name 3 signs of haemorrhagic pancreatitis

A

Cullen’s sign: periumbilical ecchymosis + discoloration
Grey Turner’s sign: flank ecchymosis + discoloration
Fox’s sign: ecchymosis over inguinal ligament

21
Q

What is the diagnostic criteria for acute pancreatitis?

A

2 of:
Characteristic abdo pain
↑ Serum pancreatic enzymes: lipase or amylase ≥ 3× ULN
Characteristic findings on cross-sectional imaging (e.g. contrast enhanced CT)

22
Q

What bloods are seen in acute pancreatitis?

A

WCC: High
U+Es: ?dehydration)
LFTs: deranged if gallstones or alcohol
CRP: High
LDH: High
Glucose: High
Lipase: High
Amylase: High
Calcium: Low

23
Q

Describe the use of serum amylase in diagnosis of pancreatitis

A

Raised in 75%; typically >3x upper limit of normal
Levels do NOT correlate with disease severity
Specificity for pancreatitis is ~90%

24
Q

List 5 causes of raised amylase other than acute pancreatitis

A

Pancreatic pseudocyst
Mesenteric infarct
Perforated viscus
Acute cholecystitis
DKA

25
Q

Describe use of serum lipase in diagnosis of acute pancreatitis

A

More sensitive + specific than amylase
Also has longer half-life than amylase + may be useful for late presentations > 24h

26
Q

Other than bloods, what investigations may be performed for acute pancreatitis?

A

ABG: ?hypoxia or metabolic acidosis
USS: ?gallstones/ biliary obstruction
Erect CXR: ?pleural effusion/ bowel perforation
CT: if dx uncertain or persisting organ failure

27
Q

List 3 scoring systems is used in assessment of acute pancreatitis?

A

Glasgow-Irmie Score
APACHE-II Score
Ranson score

28
Q

What parameters are used in the Modified Glasgow score?

A

PaO2 <8 kpa
Age >55
Neutrophils, WCC >15
Calcium <2
Renal, urea >16
Enzymes, LDH >600 or AST >200
Albumin <32
Sugar, glucose >10

29
Q

Describe the immediate management of Acute Pancreatitis

A

Fluid + electrolyte resus
Analgesia +/- Antiemetics
Early feeding (NG tube if vomiting)
?HDU + ITU care

30
Q

When should antibiotics be used in acute pancreatitis?

A

ONLY if evidence of infected necrosis.

31
Q

Describe definitive management of biliary pancreatitis

A

Gallstone pancreatitis + cholangitis: ERCP
Gallstone pancreatitis without cholangitis/ bile duct obstruction: Cholecystectomy
Gallstone pancreatitis with bile duct obstruction: ERCP + sphincterectomy

32
Q

Describe management of alcohol related acute pancreatitis

A

Vitamin supplementation: Thiamine, Folic acid, Cyanocobalamin
Brief alcohol counselling during admission

33
Q

When and what surgical methods are used in acute pancreatitis?

A

Necrotising pancreatitis

Necresectomy (drainage + debridement of necrotic tissue)

34
Q

What 4 local complications may arise from acute pancreatitis?

A

Pancreatic necrosis
Abscess (infected necrosis of pancreas)
Pseudocyst (typically several weeks later)
Chronic pancreatitis (fibrotic scarring; typically from alcoholic pancreatitis)

35
Q

What 5 systemic complications may arise from acute pancreatitis?

A

ARDS
DIC
Electrolyte derangement (typically Hypocalcaemic)
Glucose homeostasis derangement (H or L)
Hypovolaemic shock

36
Q

What should you check about the patient’s PMH?

A

Hx of high alcohol intake
Hx of gallstones

37
Q

Describe management of pancreatic necrosis

A

Sterile necrosis: conservatively (at least initially)
Early necrosectomy is a/w a high mortality rate (+ should be avoided unless compelling indications for surgery exist)

YR6: GASTRO (61 decks)

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