Acute pancreatitis Flashcards
What percentage of pancreatitis cases are mild to moderate?
70-85%
What is the pain like in acute pancreatitis?
steady and persistent for many hours. N/V
Pain is worse in the upper quadrants
What additional Sx will a pt with SEVERE acute pancreatitis have?
Tachycardia Mental status changes Hypotension Hypoxia Fever
Would the abdomen be rigid in pancreatitis?
NO–that’s a peritoneal sign.
Grey-turner sign
ecchymosis in the flank region
Cullen sign
ecchymosis in the periumbilical region
What other things could cause an elevated amylase besides pancreatitis?
Cholecystitis Bowel obstruction/perforation Intestinal ischemia Appendicitis Ectopic pregnancy Overian cysts Lung cancer Drugs ERCP
Why is the serum lipase more sensitive?
All lipase comes from the pancreas
What other labs might be abnormal
WBC high, esp in severe pancreatitis
Glucose and LFTs high if gallstones are present
Calcium low
What imaging tests might help?
Plain abdominal films excludes perforation and intestinal obstruction
Abdominal CT: shows inflammation of pancreas, extent of inflammation, and necrosis
What is the downside to using a CT in suspected pancreatitis?
It may be normal in 15-30% of pts with mild pancreatitis won’t show early signs in CT
What criteria are used to diagnose acute pancreatitis?
- Abdominal pain consistent with acute pancreas
- elevated amylase/lipase 3x normal limit
- confirmation with X-sect abd imaging
What’s your differential for pancreatitis?
cholecystitis cholangitis perforation mesenteric ischemia intestinal obstruction
MI
aortic dissection
ectopic pregnancy
crohn’s
What are the two most common causes of acute pancreatitis?
alcohol abuse and gallstones (these comprise 80% of cases)
Do gallstones lead to chronic pancreatitis?
No–while alcohol can cause permanent structural changes, intermittent obstruction of the pancreatic duct usually does not.
What are less common causes of acute pancreatitis?
idiopathic (10-15%) Hereditary Hyperparathyroidism/hypercalcemia Cancer medications hepatitis toxins (trinidadian scorpion) ERCP Trauma Inherited Pregnancy
What are three inherited causes of acute pancreatitis?
- Trypsinogen mutation (loss of inactivation binding site)
- CFTR mutations: thickened mucus causes obstruction of bile duct, inaddition to malabsorption
- Familial hypertriglyceridemia
How do you determine the severity of pancreatitis?
Use the ranson index, with 11 variables.
What is missing from the ranson index?
amylase/lipase elevation! These are elevated both in acute and chronic cases and don’t tell you more than that.
Aside from the ranson index, what other prognostic indicators are there?
BISAP>2
- BUN>25
- Impaired mental status
- SIRS
- Age>60
- Pleural effusion
What are early complications of severe acute pancreatitis?
- massive dehydration
- hyperglycemia, hypocalcemia, electrolyte abnormalities, coagulopathy and hypoxia
- SIRS
What is SIRS?
Systemic inflammatory response syndrome: Fever, tachycardia, tachypnea, elevated WBC
What are the late complications of acute pancreatitis?
Occurs after the 2nd week. Pseudocysts, abscesses, and GI hemorrhage
–>death from SIRS/sepsis/multiorgan failure. Can occur at any time.
How do you treat sterile necrosis of the pancreas? Infected necrosis?
- Antibiotics, conservative
2. Antibiotics, debridement
