Acute Pancreatitis Flashcards
Define acute pancreatitis.
What are causes of acute pancreatitis?
top causes- gallstones, excess alcohol consumption, trauma (ERCP), hypercalcemia, steroids.
Describe the pathophysiology of acute pancreatitis and its sequelae.
premature exaggerated activation of enzymes due to bile –>
(A) increased amylase –> lipase –>
1. lipase –> fat digestion –> fat necrosis –> increased fatty acids –> bind to calcium –> hypocalcemia
2. peripancreatic digestion –> invasion –> abscess –> spiking fever –> sepsis
3. vessel digestion –> intraparenchymal or retroperitoneal haemorrhage –> cullen’s or grey turner’s sign
(B) Failure of islets of langerhan –> decreased insulin –> severe hyperglycemia
(C) systemic inflammatory response –> increased global vascular permeability –> fluid shift in the 3rd space (1st space - intracellular, 2nd - extracellular, 3rd - intra and extra peritoneal or anywhere else)
What are the common symptoms of acute pancreatitis?
What exam findings would you expect to find in acute pancreatitis.
What are the ddx for acute pancreatitis?
What would you expect to find on CXR of acute pancreatitis?
What would you expect to find on Abdominal Xray of acute pancreatitis?
What would you expect to find on CT contrast of acute pancreatitis?
What scoring is used?
When is this typically performed?
1)Outline the components of the glasgow criteria
2) when should this score be carried out?
3) state the interpretation of its results.
for risk stratification
What investigations will you order for acute pancreatitis?
+ CRP to monitor disease activity
List the complications of acute pancreatitis.
Other than the glasgow criteria, what other criterias can be used? How is it different to the glasgow criteria.
other - apache
What would you expect to find on a CXR of ARDS?
What would you see on CT pancreas in the setting of hypocalcemia?
in peripancreatic fat
What are the systemic complications of acute pancreatitis?
+ mortality
What are the local complications of acute pancreatitis? List ttek… don’t be trying to show off now. Yes you Abdul!
peripancreatic necrosis
pancreatic abscess
pancreatic pseudocyst
chronic pancreatitis
pancreatic haemorrhage
How does pancreatitis cause transverse colon necrosis.
peripancreatic necrosis spreading to surrounding organs.
Define peripancreatic necrosis. When should it be suspected and how is diagnosed?
How would you treat peripancreatic necrosis or gangrene?
necrosectomy and drainage
What is a pancreatic abscess. How does it present and what is the tx?
What is a pancreatic pseudocyst? What are the possible sequelae? How is it managed?
How would the glasgow criteria affect you management plan for acute pancreatitis?
if severe - 3+ - HDU or ICU
Why are PPIs give in acute pancreatitis?
to prevent stress ulceration
A patient with acute pancreatitis is requiring a calcium infusion. What cautions should be taken when delivering the infusion?
Calcium infusions, particularly intravenous calcium gluconate or calcium chloride, are often administered in a High Dependency Unit (HDU) or Intensive Care Unit (ICU) due to the potential cardiac risks associated with its administration and the need for close monitoring.
Outline the management of acute pancreatitis and its complications.
Outline the measures to prevent recurrence of acute pancreatitis.
What are 2 poor prognostic factors of acute pancreatitis?
