Acute pancreatitis Flashcards
What is acute pancreatitis?
Acute pancreatitis refers to acute inflammation of the pancreas
What is the epidemiology?
In the United Kingdom, the prevalence of pancreatitis is around 56 cases per 100,000 annually.2
Though it is mild in most people (mortality <1%), patients can deteriorate quickly. There is a high mortality rate (~15%) in patients with severe pancreatitis.
True or false: pancreatic function typically returns to normal after acute pancreatitis
true
What are the three main causes of acute pancreatitis?
1) gallstones
2) alcohol
3) post-endoscopic retrograde cholangiopancreatography
What does ERCP stand for?
endoscopic retrograde cholangiopancreatography
Describe how gallstones can cause acute pancreatitis: (2)
1) gallstones get trapped at the ampulla of Vater, blocking the flow of bile and pancreatic juice into the duodenum
2) reflux of bile into the pancreatic duct and prevention of pancreatic juice containing enzymes from being excreted results in inflammation of the pancreas
In what two patient demographics is gallstone pancreatitis more common?
- women
- elderly
What mnemonic can be used to recite the causes of acute pancreatitis?
I GET SMASHED
Using the mnemonic I GET SMASHED, give the causes of acute pancreatits:
1) Idiopathic
2) Gallstones
3) Ethanol
4) Trauma
5) Steroids
6) Mumps
7) Autoimmune
8) Scorpion sting
9) Hyperlipidaemia
10) ERCP
11) drugs
Name 3 drugs that can cause acute pancreatitis:
1) furosemide
2) thiazide
3) azathioprine
What digestive enzyme causes most of the damage in acute pancreatitis?
trypsin
Give 4 clinical symptoms seen in acute pancreatitis:
- Severe epigastric pain that radiates through to the back
- associated vomiting
- abdominal tenderness
- systemically unwell (low grade fever, tachycardia)
- Maybe mild jaudice
What is cullen’s sign?
Bruising at the umbilicus due to retroperitoneal bleed seen in severe necrotising pancreatitis
What is grey turner’s sign?
Bruising at the flank due to retroperitoneal bleed seen in severe necrotising pancreatitis.
Give two examination findings associated with acute pancreatitis:
1) abdominal tenderness and guarding
2) reduced or absent bowel sounds
What serum test is extremely sensitive to acute pancreatitis?
serum amylase
After how many days does serum amylase return back to normal levels following acute pancreatitis?
3-5 days (late presentations can therefore be missed)
Name 3 specific blood tests used to monitor inflammation of the pancreas:
1) serum amylase
2) serum lipase
3) CRP
Which is elevated for longer in acute pancreatitis, serum amylase or serum lipase?
serum lipase
Name 6 baseline investigations used to manage abdominal pain which should be repeated every 24 hours:
1) FBC
2) U&Es
3) serum creatinine
4) LFTs
5) blood glucose
6) ABG
What imaging method is used to identify gallstones?
abdominal ultrasound
What imaging method is used to assess pancreatic necrosis?
CT abdomen
After how many hours after an acute pancreatic episode should CT abdomen be used to assess the extent of pancreatic necrosis?
72 hours
Why is an erect CXR offered to all those with a suspected acute pancreatitis?
to exclude gastroduodenal perforation (which can also raise serum amylase)
What is systemic inflammatory response syndrome?
2 or more of the following in the context of inflammation:
1) fever/hypothermia
2) tachycardia
3) tachypnoea
4) leukocytosis/leukopenia
What is the Glasgow score used for?
to assess the severity of pancreatitis
Give the 8 features of the Glasgow score:
1 point for each of the following:
1) PaO2 <8kPa
2) Age >55
3) Neutrophils WBC >15
4) Calcium <2
5) urea >16
6) enzymes (LDH >600 or AST/ALT >200)
7) albumin <32
8) sugar (glucose >10)
Describe the Atlanta criteria:
classes acute pancreatitis as mild, moderate or severe using the absence or presence of organ failure
Describe the Marshall scoring system:
gives points from 0-4 based on blood pressure, serum creatinine and PO2
Describe the Ranson scoring system:
similar to the Glasgow criteria but looks at some additional biochemistry such as aminotransferase, haematocrit fall and base deficit
Name 4 pancreatic severity/ prognosis scoring systems:
1) Glasgow score
2) Marshall scoring system
3) Atlanta criteria
4) Ranson scoring system
True or false: moderate or severe cases of acute pancreatitis should be admitted to the intensive care unit
True
Give 8 points of management for acute pancreatitis:
1) initial resuscitation (ABCDE)
2) IV fluids
3) nil by mouth (NG)
4) Analgesia
5) careful monitoring using scoring systems
6) treatment of gallstones
7) antibiotics (if evidence of infected necrotic area or abscess)
8) treatment of complications e.g. drain abscess
Give 2 ways in which you can remove gallstones?
1) cholecystectomy
2) ERCP
What is the preferred analgesic for acute pancreatitis?
tramadol
Give 2 systemic complications of acute pancreatitis:
1) systemic inflammatory response syndrome
2) multiorgan dysfunction
Give 4 pancreatic complications of acute pancreatitis:
1) pancreatic fluid collections
2) necrosis
3) pancreatic abscess
4) pancreatic pseudocyst (forms 4-6 weeks after)
Give 3 lung complications of acute pancreatitis:
1) pleural effusion
2) acute respiratory distress syndrome
3) pneumonia
Give a kidney-related complication of acute pancreatitis:
AKI
Give 2 GI-related complications of acute pancreatitis:
1) GI bleed for gastric or duodenal erosions
2) paralytic ileus
Give 3 hepatobiliary complications of acute pancreatitis:
1) jaundice
2) common bile duct obstruction
3) portal vein thrombosis
Give 3 metabolic complications of acute pancreatitis:
1) hypoglycaemia
2) hyperglycaemia
3) hypocalcaemia
Give a haematological complication of acute pancreatitis:
disseminated intravascular coagulation (DIC)
What is the most common cause of chronic pancreatitis?
Alcohol
Describe how alcohol can cause pancreatitis: (2)
1) ethanol increases intracellular calcium which promotes trypsinogen activation to trypsin
2) this increases intrapancreatic enzyme activity, causing calcification and ductal obstruction
Give 3 genetic mutations associated with chronic pancreatitis:
1) SPINK-1
2) CASR
3) CFTR
Give 4 complications associated with chronic pancreatitis:
1) loss of endocrine function (lack of insulin)
2) loss of exocrine function (lack of enzymes)
3) chronic epigastric pain
4) damage and strictures to the duct system resulting in obstruction
Give 5 treatment methods for chronic pancreatitis:
1) abstinence from alcohol and smoking
2) analgesia
3) enzyme replacement (Creon)
4) insulin
5) ERCP with stenting to treat strictures and obstruction
