Acute Pancreatitis Flashcards
What is the acronym for remembering the causes of acute pancreatitis?
I GET SMASHED
What does I GET SMASHED stand for?
Idiopathic, gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion venom, hyperlipidaemia/hypercalcaemia/hypothermia, ERCP, drugs (diuretics/immunosuppressants)
What percentage of cases are caused by gallstones and alcohol?
80%
What occurs in acute pancreatitis?
Insult to the pancreas causes pancreatic enzymes to leak and autodigest the pancreas parenchyma causing damage and self perpetuating inflammation
What response may be activated by acute pancreatitis?
The SIRS
What are the two most severe complications of acute pancreatitis?
Haemorrhagic pancreatic necrosis
Infected pancreatic necrosis
What percentage of cases are mild?
80%
What are the symptoms of acute pancreatitis?
Generalised or sudden severe epigastric pain/central abdominal pain, pain radiates to the back, pain relieved by sitting forward, nausea and vomiting
What are the signs of acute pancreatitis?
Tachycardia, shock, fever, ileus, guarding, left flank tenderness, Cullens sign, grey-turners sign
What is Cullens sign?
Peri-umbilical discolouration
What is grey-turners sign and what causes it?
Bruising on the left flank due to blood vessel autodigestion and haemorrhage
What investigations would you do?
Amylase levels, serum lipase, LFTs, USS, AXR, CXR, CT, CRP
At what level is amylase diagnostic?
When it is above 3 times the normal limit
Why might amylase be normal?
As amylase levels fall within 24-48hrs
What co-morbidity may increase the amylase levels?
Renal failure as this causes means less amylase is excreted
What other conditions may raise amylase?
Cholecystitis, peptic ulcer, pregnancy, mesenteric infarction, rhabdomyolysis
Why is serum lipase a better test?
It is both more sensitive and more specific
What might an AXR show?
Loop of proximal jejunum on causes by local ileus known as a sentinel loop
What might the CT show?
The extent of necrosis of the pancreas and the areas affected
What are the early complications?
Hypovolemic shock, hypocalceamia, diabetes, DIC, respiratory failure, renal failure
Late complications include? (After 1 week)
Pancreatic necrosis, pseudocyst with fever, abscesses, bleeding, thrombosis in splenic/gastroduodenal arteries causing bowel necrosis, fistula, recurrent oedematous pancreatitis
What is the management? In mild patient
ABC assessment, oxygen, Severity assessment, nil by mouth, LOTS of IV saline (renal failure), urinary catheter, morphine, hourly monitoring, ITU if worsening
If the patient is still worsening, what management would you do?
Antibiotics if >30% necrosis eg IV imipenem, pareneternal nutrition and necrosectomy, ERCP if there is progressive jaundice
What differential would you consider?
Any acute abdomen but especially mesenteric infarction/perforated peptic ulcer
What is the associated mortality of acute pancreatitis?
12%
What does the PANCRES severity assessment stand corrected?
PaO2 (less than 8kPa), age (>55), neutrophillia, calcium low (most prognostic of death), renal function (urea above 16 (norm=1.8-7.1)), enzymes (raised LDH and AST), blood glucose above 10
How many criteria must be met to be classed as severe?
3
