Acute pancreatitis Flashcards
what is acute pancreatitis?
inflammation on a background of a normal anatomical and functional pancreas.
Pancreas returns to normal
What is chronic pancreatitis?
inflammation of the pancreas that is recurrent and leads to irreversible structural changes,
What are the causes of acute pancreatitis?
I GET SMASHED
I GET SMASHED I - idiopathic G - gall stones (40%) E - alcohol excess T - trauma S - steroids M- mumps (coxsackie B) A - autoimmune (tumour) S - scorpion stings H - hyperlipidaemia / Hypercalcaemia E - ERCP D - drugs (azathioprine, diuretics like furosemide, oestrogens, corticosteroids, didanosine, Abx like tetracycline)
What are the symptoms of acute pancreatitis?
SOCRATES S - epigastric pain O - after alcohol binge C - severe, agonising R - bores through to back A - gallstones, nausea, vomiting, retching, fever T - constant E - aggravated by eating fatty food. S - SEVERE.
(peritonitis as inflammation spreads through abdo)
What are the signs of acute pancreatitis on examinationʔ
- swollen , tender abdo
- gaurding
- decreased or absent bowel sounds
- fever
- increased heart rate
- hypotension
- oliguric (decreased urine ouput)
ɴecrotising pancreatitisː
- Cullen’s (periumbical bruising
- ɢrey-turner’s sign (flank bruising)
-jaundice or cholangitis (gallstone obstruction)
What Blood investigations are done for suspected acute pancreatitis
1) BʟOODSː
- serum amylase (raised 3X)
- urinary amylase (raised)
- serum lipase (raised)
- CʀP
- FBC, U&E, ʟFT,
- ɢlucose
- Plasma Calcium
- ABɢ at 24hs and 48hrs
What does the serum amylase show in acute pancreatitisʔ
- serum amylase will be 3X the normal upper limit when measured within 24hrs of onset of pain ( 300+ is deffo acute pancreatitis), they then fall over the next 3 to 5 days.
What are the other causes of elevated serum amylase other than pancreatitisʔ
- upper ɢɪ perforation
- biliary peritonitis
- intestinal infarction
- congenital macroamylasaemia
What radiological invx are done for acute pancreatitisʔ
1) CXʀ (to exclude gastroduodenal perforation as the cause of raised serum amylase)
2) Abdo USS (gallstoneʔ bile duct obstructionʔ)
3) contrast enhanced CT (essential for all but mild attacks of pancreatitis to assess pancreatic necrosis)
4) MʀCP (Mʀɪ to asses pancreatic damage and gallstones in biliary tree)
5) ECʀP (to remove bile duct stones)
Why do we do CXʀ for acute pancreatitisʔ
- to exclude gastrodudoenal perforation as the cause of raised amylase.
- gallstone / pancreatic calcifation
Why is essential to do contrast enhanced spiral CT for acute pancreatitisʔ
Contrast enchanced spiral CT is necessary for all but mild attacks.
Do after 72hrs to asses pancreatic necrosis and complications.
What are the complications of pancreatitisʔ
- haemodynamic instability
- multiple organ failure
What is the assessment for predicting severity of acute pancreatitisʔ
Modified ranson and glasgow criteriaː
ɪf 3 or more of the following within the 1st 48hours than send to ɪTU.
PAɴCʀEAS
P - PaO2 <8KPa
A - Age >55
ɴ - ɴeutrophils WCC > 15 x 10^9
C - Calcium < 2mmol/ʟ
ʀ - ʀenal function urea > 16mmol/ʟ
E - enzymes ʟDɢ > 600ɪU/ʟ, AST > 200 ɪU/ʟ
A - albumin < 32g/ʟ
S - sugar blood glucose > 10mmol/ʟ
What is the APACʜE scoreʔ
APACʜE score = acute physiology and chronic health evalutation score it is used to predict severity in a number of diseases. ɪt is adjusted fo age and other chronic health problems.
ɪt is very sensitive even in the 1st 24hrs of acute pancreatitis presentation
ɢallstones cause 40% of acute pancreatitis.
ɪf no gallstone is found on USS , what other test can indicate its prescence and cause of acute pancreatitisʔ
AʟT (alanine transminase ) will be elevated 2X the upper limit - this is highly suggestive of a gallstone cause of acute pancreatitis.
