Acute Pancreatitis Flashcards
Acute pancreatitis
Acute inflammation of pancreasis causing release of exocrine enzymes that autodigest the organ
Causes of pancreatitis
GET SMASHED
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion sting
- Hypertriglycerides, hpothermia, hypocalcaemia
- ERCP
- Drugs (azathioprine, diuretics)
Pathophysiology acute pancreatitis
- trigger causes increase intracellular Ca2+
- activation of intracellular proteases & release of exocrine enzymes
- acinar cell injury and necrosis
- local to systemic inflammatory response & organ failure
Clinical symptoms of acute pancreatitis
- acute onset, severe abdo pain (may radiate to back)
- nausea and vomiting
- jaundice (+/-)
- pyrexia (+/-)
Clinical exam findings in acute pancreatitis
systemic:
- fever (+/-)
- hypotension
- techycardia
- tachypnoea
Abdominal:
- tenderness, local gurading
- ditension/ascites
- Grey Turners & Cullens Sign
Respiratory:
- reduced SpO2
- acute resp distress syndrome
- pleural effusions
Grey Turners Sign
Flank bruising
(seen in acute pancreatitis)
Cullens Sign
Peri-umbilical bruising
(seen in acute pancreatitis)
Investigating acute pancreatitis
Bloods:
- raised amylase
- raised lipase
- raised CRP
- reduced calcium
Scoring severity of acute pancreatitis
Glasgow Pancreatitis Score
Glasgow Pancreatitis Score
PANCREAS
- PaO2 (down)
- Age (up)
- Neutrophils (up)
- Calcium (down)
- Renal serum urea (up)
- Enzymes LDH (up)
- Albumin (down)
- Sugar (up)
Managing acute pancreatitis
- Nil by mouth (NG tube if vomiting)(aim to reintroduce nutrition as early as possible)
- IV fluid resuscitation and supplemental O2
- analgesia (hand held morphine pump)
- monitoring BP, BG (?insulin, vasopressors)
Local complications acute pancreatitis
5P’s
- pseudocyst
- pancreatic abscess
- pancreatic necrosis
- pancreatic fistula
- pancreatitis chronic
Systemic complications acute pancreatitis
DR SAM
- Disseminated intravascular coagulation
- Renal failure
- Sepsis
- Acute resp. distress syndrome
- Multi-organ failure
