Acute Pancreatitis Flashcards
What is acute pancreatitis
acute inflammation of the pancreas varying from mild edema to severe hemorrhagic necrosis
In whom is it common to have acute pancreatitis
middle aged men and women equally
Who has a higher rate of acute pancreatits blacks or whites and by who much?
Blacks. Three times higher than whites
First and second most common causes of acute pancreatits?
- Gall bladder disease which is more common in women
2. chronic alcohol intake which is more common in men
Common acute pancreatitis is associated with what risk factors?
- Smoking - independent risk factor
- Biliary sludge or microlithiasis - mixure of cholesterol crystals and calcium salts found in some patients
- Hypertriglyceridemia - 1000mg/dl+
Leas common risk factors associated with acute pancreatitis?
Less common:
- trauma (post surgical, ab)
- viral infections (mumps, HIV)
- penetrating duodenal ulcer
- cyst
- abscesses
- cystic fibrosis
- Kaposi sarcoma
- certain drugs (corticosteroids, oral bc, sulfonamides, NSAIDS, thiazide diuretics)
- metabolic disorders (hyperthyroid, renal failure)
- Vascular disease
Pancreatitis may occur after surgical procedures on the:
pancreas, stomach, duodenum or biliary tract
endoscopic retrograde cholangiopancreatography (ERCP)
How pancreatitis affects the pancreas?
injury pancreatic cells or active the pancreatic enzymes in the pancreas and not in the intestine. Which may be due to reflux of bile acids in the pancreatic ducts
Why is it important Trypsinogen or Trypsin (the active form) is only activated in the intestine?
Because if its active in the pancrease it digest the pancreas and produces bleeding
Patients with sever pancreatitis have a high risk of developing:
pancreatic necrosis
organ failure
septic complications
mortality (25% chance)
Clinical Manifestations: Predominant & why = Location = *Onset = *Description of pain =
Predominant = abdominal pain which is dues to a distended pancreas, peritoneal irritation and obstruction of bilary tract
Location: left upper quadrant and maybe the midepigastrium and radiates to the back
Onset: sudden**
Description: sever, deep, piercing and continuous/steady***
Other clinical manifesetations:
- abdominal tenderness with guarding is common
- decreased or absent bowel sounds
- paralytic ileus
- crackles in lungs
- cyanosis or green areas
- shock
- hypovolemia
Disease severity depends on
extend of pancreatic destruction
Two complications of acute pancreatitis
pseudocyst and abscess
What is a pancreatic pseudocyst?
What are the manifestations?
acummulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall
manifestations: ab pain, palpable epigastric mass, n/v, and anorexia. Elevated serum amalyse level.
Pancreatic psudocyst diagnostic test and treatment?
CT, MRI and endoscopic ultrasound (EUS)
Cyst usually resolve spontaneously within a few weeks by may perforate causing peritonitis or rupture into the stomach or duodenum. Treatment: surgical drainage, percutaneous catheter placment and drainage and endocscopic drainage
What is a pancreatic absces?
Collection of pus resulting from extensive necrosis in the pancrease and can become infected or perforate into adjacent organs
Pancreatic abscess clinlical manifestations
upper ab pain
ab mass
high fever
leukocytosis
Pancreatic abscess treatment
prompt surgical drainage to prevent sepsis
Main systemic complication of acute pancreatitis
pulmonary complications - PE, atelectasis, pneumonia and acute respiratory distress syndrome
cardiovascular complications - hypotension
tetany caused by hypocalcemia
Diagnostic Studies
What are they and which ones are more accurate?***
**Serum amylase and serum lipase elevated. Serum lipase is the best because amylase is only elevated 24-72 hours and can be elevated because of other reasons.
Abdominal ultrasound, xray and contrast-enhanced CT scan. CT scan is the bes imaging test for pancreatities and complications to be identified.
Other: ERCP but it can cause pancreatitis. EUS, MRCP and angiography. Chest xray to monitor for pulmonary changesq
Collaborative care goals
- relieve pain
- prevent or alleviation of shock
- reduce pancreatic secretions
- correct fluid and electrolyte imbalance
- prevent or treat infections
- removal of the precipitating cause if possible
TREATMENT IS FOCUSED ON SUPPORTIVE CARE
Conservative care therapy interventions
- aggressive hydration
- pain meds
- give dextran or albumin for schock to replace blood volume
- give lactated ringer solutions or other electrolyte solutions to balance fluid and electrolyte
- for hypotension give vasoactive drugs to increase vascular resistance (vasocontriction)
- reduce or suppress pancreatic enzymes to decrease pancreas stimulation, place NPO & then insert NG tube when cured they can eat orally
- antibiotics if necrosis or infection occur
Surgical Therapy
- severe acute pancreatits may require drainage = surgically or under CT guidance or endocopically.
- percutaneous drainage of cyst can be performed with a tube left in place
- when pancreatitis is related to gallstones and urgent ERCP plus sphincterotomy may be done
