Acute Pancreatitis Flashcards
A 45-year-old male who was diagnosed and managed for acute pancreatitis two weeks ago presents with tachycardia, tachypnoea, and shortness of breath.
What are your differentials?
- Relapse of pancreatitis
- Pancreatic pseudocyst
- ARDS
- Cholecystitis
- Ascending cholangitis
- Appendicitis/ peritonitis
A 45-year-old male who was diagnosed and managed for acute pancreatitis two weeks ago presents with tachycardia, tachypnoea, and shortness of breath.
Why is the patient tachypneic?
- Abdominal pain
- Pseudocyst pressure
- ARDS
- Infection, Sepsis, shock
What are the scores you can use for pancreatitis?
- Glasgow-Imerie score:
you do not need to memorise any numbers, just the criteria
PANCREAS- Pao2 < 8 kpa (10-13)
- Age > 55
- Neutrophils > 15,000
- Calcium < 2 mmol (after 48h)
- Renal (urea) > 16 (2.5-6.7) mmol/L
- Enzymes (LDH) > 600 (after 48h)
- Albumin < 32 g/L (after 48h)
- Sugar (glucose) > 10 mmol/L
- Ranson’s:
5 criteria on admission, 6 criteria at 48 hours. Score out of 11, above 7 is 100% mortality - Balthazar CT scoring system:
a. Normal
b. focally or diffuse Enlarged
c. Inflamed
d. Single fluid collection
e. 2 or more fluid collection - APACHE II
- Acute physiological assessment & Chronic health evaluation 2
What is management of pancreatitis?
- NBM → TPN early feeding with NJ tube
- IVF, Catheter
- Analgesia (no morphine spasm sphincter, no NSAIDS gastric ulcers) → Epidural , PCA
- Antipyretic, anti-emetic
- Antibiotics if pancreatic necrosis (metronidazole, amoxicillin, genta)
- Octreotides (somatostatin)→ decrease panc secretions , IV PPI
- Steroids in Severe inflammation
What are the complications of pancreatitis?
- Local: pseudocyst, abscess, necrotising pancreatitis, haemorrhagic pancreatitis
- Organs damage
- Acute renal failure
- Acute respiratory distress syndrome
- Disseminated intravascular coagulation
- Ileus
- Jaundice
- Serious: Shock, sepsis, , death
- Metabolic: low Ca, High glucose
What are the causes of pancreatitis?
GET SMASHED
Explain the Pathogenesis of pancreatitis due to gall stones
- Duct obstruction → reflux of bile → increased pressure → pancreatic acinar damage
- Lipase causes fat necrosis
- Elastase destroys blood vessels → hemorrhage → hemorrhage pancreatitis
What is the function of the pancreas?
- Endocrine: glucagon, insulin, somatostatin, pancreatic polypeptide
- Exocrine: Lipase, phospholipase A2, Amylase, Proteases: Trypsinogen Chymotrypsinogen
What CT findings in pancreatitis?
CT used to judge severity/complications, usually considered at 4-5 days after presentation in mild to moderate cases
- Edema, fat strandings
- Pseudocyst
- Collection, abscess, necrosis
What is the management of Splenic vein thrombosis
- Conservative:
- LMWH
- Thrombolytic therapy
- Endovascular embolization
- Surgical resection
Why is the Amylase not important for assessing pancreatitis? what other enzymes would you check?
- returns to normal after 48h
- Non-specific: also raised in pancreatic cancer, acute cholecystitis, alcohol consumption.
- does not correlate with severity
- tends to be normal in cases of acute on top of chronic pancreatitis
- Look at Amylase, lipase, LDH
What are factors affecting pancreatic secretions?
Definition of pseudocyst
Collection of amylase-rich fluid enclosed in fibrous/granulation tissue wall in the lesser peritoneal sac- It requires 4 weeks or more from the onset of the attack
what is the pathophysiology low Ca in pancreatitis?
- Early: Autodigestion mesenteric fat by pancreatic enzymes → fatty acids chelate calcium forming calcium salts
- Late: Sepsis → Catecholamines → move Ca intracellular
What is the pathophysiology of high glucose in pancreatitis?
- Destruction of B Islets of Langerhans → no insulin → high glucose
- Stress response
