Acute Pancreatitis Flashcards
What is acute pancreatitis?
Acute inflammation of the pancreas, releasing exocrine enzymes (amylase, protease, and lipase) that cause auto-digestion of the organ
Acute pancreatitis can lead to serious complications and requires prompt medical attention.
What are the two types of acute pancreatitis?
- Mild: resolves without serious complication
- Severe: complication by one or more organ failures
The classification of severity is crucial for management and prognosis.
What mnemonic is used to remember the causes of acute pancreatitis?
I GET SMASHED
This mnemonic helps to recall common causes, including gallstones and alcohol.
What are common causes of acute pancreatitis?
- Idiopathic
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion sting
- Hyperlipidaemia/hypercalcemia
- ERCP
- Drugs
These are significant risk factors for developing acute pancreatitis.
What are the risk factors for acute pancreatitis?
- Past history of gallstones
- Alcohol consumption
Identifying risk factors is important for prevention and management.
What are the symptoms of acute pancreatitis?
- Sudden onset, severe epigastric/LUQ pain, relief sitting forward
- Nausea/Vomiting
Symptoms can vary but are typically severe and sudden.
What are the signs of acute pancreatitis?
- Signs of shock (cyanosis, hypotensive, tachycardic, high respiratory rate, reduced skin turgor, reduced urine output)
- Jaundice (gallstones)
- Signs of alcoholic liver disease
- Generalised tenderness
- Absent bowel sounds
- Rare: epigastric mass, Cullen’s sign, Grey-Turner sign
These signs can indicate the severity and complications of the condition.
What is Cullen’s sign?
Periumbilical bruising
Cullen’s sign is a rare sign associated with severe acute pancreatitis and indicates internal bleeding.
What is Grey-Turner sign?
Flank bruising
Like Cullen’s sign, Grey-Turner sign is indicative of severe pancreatitis and possible hemorrhage.
What are the differential diagnoses for acute pancreatitis?
- Intestinal perforations
- Burst abscess/diverticular
- Ischaemic bowel
- Dissecting AAA
- Pyelonephritis
It’s important to rule out these conditions as they may present with similar symptoms.
What immediate investigations are needed for acute pancreatitis?
- Urine dip
- Bloods: FBC, U&E, LFTs, Serum amylase - raised in AP
- ECG
- Erect CXR - free air under diaphrgam suggests perf
- AXR
- Blood gases
These tests help in diagnosing and assessing the severity of pancreatitis.
What tests are ASAP required to diagnose pancreatitis?
- LDH
- Blood sugar
- Calcium
- Abdominal USS - gallstones/biliary dilatation
These tests can provide critical information about the patient’s condition.
What imaging techniques may be used if required for pancreatitis?
- MRCP
- ERCP
- CT
These imaging techniques help visualize the biliary tree and assess for complications.
What are the components of acute management for pancreatitis?
- Oxygen
- IV fluids
- Analgesia
- Catheter for urine output
Immediate supportive care is crucial in managing acute pancreatitis.
What is the Glasgow Prognosis Score (GPS) used for?
To indicate severity of pancreatitis and indicates HDU admission with more intensive monitoring if patient score is 3+
A higher score correlates with increased risk of complications.
What is the treatment for mild cases of acute pancreatitis?
- Admit the patient (you don’t know its mild until they recover)
- Analgesia
- IV/oral fluids if tolerated
- Deal with underlying cause
Patients may need close monitoring even if classified as mild.
What is the treatment for severe cases of acute pancreatitis?
- 20-30% mortality
- HDU/ITU admission
- Early ERCP for cholangitis
- Enteral nutrition
- Antibiotics (controversial)
Severe cases require intensive care and management of complications.
What are the potential outcomes of acute pancreatitis?
- Full recovery > 80%
- Pancreatic necrosis
- Abscess
- Pancreatic pseudocyst - 6wk after recovery, presents as diffuse fullness + fluid behind stomach
- Chronic pancreatitis
- Diabetes
- Death
The prognosis can vary widely based on the severity and complications.
