Acute pancreatitis Flashcards

1
Q

How common is it?

A

Accounts for 3% of all cases of abdominal pain admitted to hospital. It affects 2–28 per 100 000 of the population and is increasing in incidence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who does it affect?

A

Age >55y
BMI >30
Alcohol abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes it?

A

Acute pancreatitis occurs as a consequence of premature intracellular trypsinogen activation, releasing proteases which digest the pancreas and surrounding tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What risk factors are there (and how can they be reduced)?

A
Excessive alcohol consumption
Gallstones
Pancreatic duct obstruction
Certain drugs
Post surgery
Infection (mumps, coxsackie)
Metabolic causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does it present? What symptoms should you look out for?

A
  • Severe, constant upper abdominal pain of increasing intensity over 15-60 mins, radiating to the back
  • Nausea and vomiting common
  • Anorexia
  • Diarrhoea
  • Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What signs may the patient have on examination?

A
  • Epigastric tenderness
  • in early stages guarding and rebound tenderness usually absent, but may appear later
  • Bowel sounds quiet or absent
  • Fever
  • Tachycardia

Sometimes:

  • Jaundice
  • Dyspnoea
  • Pleural effusions

Rarely (necrotising pancreatitis):

  • Grey Turner’s sign (discolouration of flanks)
  • Cullen’s sign (periumbilical discolouration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which other conditions might present similarly?

A
Acute Mesenteric Ischemia
Acute Respiratory Distress Syndrome
Bacterial Pneumonia
Cholangitis
Cholecystitis
Chronic Pancreatitis
Colon Cancer
Colonic Obstruction
Community-Acquired Pneumonia (CAP)
Gallstones (Cholelithiasis)
Gastric Cancer
Irritable Bowel Syndrome
Myocardial Infarction
Pancreatic Cancer
Pancreatic Pseudocysts
Peptic Ulcer Disease
Viral Hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you investigate this patient?

A
Serum amylase/lipase
Pancreas US/contrast CT
Plain  x-ray (exclude other causes)
CRP (predicts prognosis)
Blood cultures (if infection suspected)
LFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would you tell the patient and how would you explain the condition to them?

A

The pancreas is an abdominal organ that secretes enzymes. For what ever reason (alcohol etc) these enzymes are now causing the pancreas to become inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?

A

The diagnosis can be very frightening and the patient/family may be worried about prognosis/recovery.
The patient may have to take a lot of time off sick.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What questions are they likely to have?

A

Why did this happen?
Is there anything I can do to stop it from happening again?
How long will it take for me to get better?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

A
Opiates for pain
IV fluids
Insulin for hyperglycaemia
NG aspiration if paralytic ileus
Enteral feeding in severe cases
Abx in necrotising cases
Cholecystectomy in cases caused by gallstones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly