Acute Pancreatitis Flashcards
What is acute pancreatitis?
Acute inflammation of pancreatic gland, is reversible
What mnemonic helps to remember the causes of acute pancreatitis?
IGETSMASHED
What are the causes of acute pancreatitis?
Think “I-GET-SMASHED”
Idiopathic
Gallstones (50%+ cases)
Ethanol (30%+ cases)
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom/ spider bite
Hypercalcaemia/ hyperlipidaemia
ERCP
Drugs (azathioprine, NSAIDs, ACE-i)
How do gallstones cause acute pancreatitis?
Gallstone obstruct the pancreatic secretions so there is an accumulation of digestive enzymes in the pancreas
What are the host defences to digestive enzymes in the pancreas?
A1AT
Pancreatic secretory transport inhibition
These become overwhelmed in acute pancreatitis due to gallstone
What happens when the host defences become overwhelmed by digestive enzymes in the pancreas (in acute pancreatitis by gallstones)?
Autodigestion of pancreas
Inflammation
Enzymes leak into blood
Increased intracellular ______ will increase p________ enzymatic activation within the pancreas, potentially leading to autodigestion
calcium
premature
What are symptoms of acute pancreatitis?
Sudden severe epigastric pain radiating to the back
Jaundice
Pyrexia
Steatorrhea
Grey Turner sign
Cullen sign
Note: autoimmune pancreatitis presents more similarly to chronic pancreatitis
Name 2 potential diagnoses for sudden severe epigastric pain radiating to the back
Acute pancreatitis
Abdominal Aortic Aneurysm (perform abdominal ultrasound)
What is the Grey Turner sign?
Discolouration of flank (sides) due to subcutaneous intra-abdominal haemorrhage
What is the Cullen sign?
Bruising around the umbilicus, indicates intraperitoneal or retroperitoneal haemorrhage
How do you diagnose acute pancreatitis?
Bloods:
Raised serum amylase/lipase (gold standard - lipase is more specific)
Raised CRP
Imaging:
Erect Chest XR to exclude gastroduodenal perforation (can also show raised amylase and lipase)
Ultrasound (to identify any gallstones)
CT abdomen (to see extent of damage and check for complications like necrosis, abscesses and fluid collections)
2 out of 3 of what things must be satisfied to diagnose acute pancreatitis?
1) Characteristic symptoms/ signs
2) Raised amylase/lipase
3) Radiological evidence
What scoring system can be used to assess severity within 24 hours
APACHE 2
(acute physiology and chronic health evaluation
What score is used to predict severity of attack after 48 hours of admission?
Glasgow and Ranson score
