Acute Pancreatitis Flashcards
Classif
Mild- no complics or organ dysfunc. Resolves.
Mod- local complics and or transient organ dysfunc. Resolves in 48hr.
Sev- persis organ dysfunc. Fail to resolve in 48hr. Complics eg panc nec, abcess, pseudocyst.
Recurrent
causes
Gallstones Alcohol misuse Endoscopy Trauma Steroids Surgery Metab conds eg hyperTG, hyperCa Infec eg mumps, cocksackie, mycoplasma pneum Drugs eg thiazide, azathiprine, tetracycline, oestrogen Mumps AI
px
Upper or gen abdo pain, sev sudden, becomes const and more sev. Us epigastric, can rad to back May worsen with movem Can be helped by fetal posit RELIEVED BY SIT UP Can be peritonitis Hx gallstones and alc NV Anorexia Rebound, guarding Distension Cullens sign- blue periumb Grey turners- blue flanks Jaundice Tachy and hypot Fever High panc enzs in blood or urine
Diffs
Ulcer Obstruc Isch bowel, mesent infarct AAA MI Bil colic Cholecystitis Cholangitis Hepatitis Gastroenteritis
Mx
Fluid Foley catheter Correct electrolytes EWS monit Alc withdrawal prophylaxis O2 Analgesia AB eg meropenem Enteral or parenteral feed ECRP Cholecystectomy Allow to eat and drink Tx the cause
ix
FBC, UE, LFT, amylase or lipase, Ca, blood gas
AXR, CXR to exclude perforat, sentinel loop
US- rule out gallst and check for pseudocyst
CT- panc nec
MRI
Do amylase once then not repeat as not marker in acute pancreatits
Dx reqs 2 of
Amylase over 3x upper limit norm
Epig pain to back
CT ev
Complics
Shock
Pulm insuffic
Metabolic imbal
DIC
Multip organ dysfunc synd due to sys cytok
Sys inflamm resp synd (SIRS)- temp under 36 or over 38, pulse over 90, RR over 20, WCC under 4 or over 12.
Panc nec
Panc abcess late
Panc pseudocyst late
Panc ascites, fistulae, duct stricture, haemorrhage
