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Tim CP3 @ UoN - Medicine & Surgery > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

How can pancreatitis be classified?

A

Severity of organ injury

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2
Q

What are the different patterns of lobule injury?

A

Periductal necrosis
Panlobular necrosis
Perilobular necrosis

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3
Q

Describe periductal necrosis

A

Necrosis of acinal cells adjacent to ducts

Due to duct obstruction

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4
Q

Describe panlobular necrosis

A

Necrosis of whole acinar lobule
Generally due to drugs/toxins/viruses/metabolic insults
Spread from periductal necrosis

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5
Q

Describe perilobular necrosis

A

Necrosis of the peripheries of lobules

Due to poor vascular perfusion

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6
Q

What are the potential early complications of pancreatitis?

A 
Shock
ARDS
Renal failure
DIC
Hypocalcaemia
Hyperglycaemia
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7
Q

Describe the aetiology of acute pancreatitis

A 
I GET SMASHED
idiopathic (20%)
gallstones (40%)
ethanol (35%)
trauma (15%)
steroids
mumps (CMV/EBV)
autoimmune
scorpion venom
hyper/hypos (lipids, calcium, thermia)
ERCP
drugs (thiazies, sulphonamides, ACEIs, NSAIDs)
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8
Q

What is the pathology underlying pancreatitis?

A

Original insult –> activated pancreatic enzymes –> acute inflammatory reaction –> local tissue necrosis –? ECF collects in gut/peritoneum/retroperitoneum

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9
Q

What are the Sx of acute pancreatitis?

A

Gradual/sudden onset severe epigastric pain
Radiates to back/relieved by sitting fowards
NAUSEA/VOMITING

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10
Q

What are the signs of acute pancreatitis?

A 
Tachycardia
Fever
Ileus
Jaundice (30%)
Rigid abdomen
Cullen's sign
Grey-Turner's sign
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11
Q

What is Cullen’s sign?

A

Periumbilical discolouration due to haemmorhage into peritoneal space

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12
Q

What is Grey-Turner’s sign?

A

Discolouration in flanks

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13
Q

What blood tests are appropriate when investigating suspected acute pancreatitis?

A

Baseline FBC, CRP, U&E, LFT, glucose, Ca
Serum amylase (v. sensitive w/i 24 hrs)
Serum lipase
ABG

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14
Q

What imaging is appropriate when investigating suspected acute pancreatitis?

A 
AXR (sentinel loop/small bowel ileus)
Erect CXR (perforations)
CT (enlarged pancreas)
MRCP
Endoscopic USS
REPEAT TEST AT 48/72 HRS TO ESTABLISH EXTENT OF NECROSIS
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15
Q

What scoring systems can be used to predict the prognosis for acute pancreatitis?

A

Modified Glasgow Criteria
APACHE II
Ranson criteria

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16
Q

Describe the Modified Glasgow Criteria

A

3 or more +ve factors w/i 48 hrs of onset suggests severe pancreatitis - PANCREAS

  • PaO2 <8kPa
  • Age >55
  • Neutrophils (WBC >15*10^9/L)
  • Calcium <2mmol/L
  • Renal urea >16mmol/L
  • Enzymes (LDH >600iu/L, AST >200iu/L)
  • Albumin <32g/L
  • Sugar (glucose >10mmol/L)
17
Q

Describe APACHE II

A

Allocates points for assessment of clinical parameters (A), age (B) and co-morbidities (C)
>9 indicates severe pancreatitis

18
Q

Describe the Ranson criteria

A

Includes age + lab scores on admission + clinical findings at 48 hrs to give mortality risk

19
Q

What are the potential late complications of acute pancreatitis?

A 
Pancreatic pseudocyst
Abscesses
Bleeding (elastase eroding major vessel)
Fistulae
Thrombosis of splenic/gastroduodenal aa (bowel necrosis)
20
Q

What is the immediate management of acute pancreatitis?

A 
A-E resus
IV fluids, catheterise
Hrly monitoring - BP, pulse, urine output
Daily bloods - FBC, U&amp;Es, Ca, glucose, ABG
Analgesia
NBM
NG tube suction (if ileus/emesis)
PPI (prevent stress ulcer)
Anticoagulation
Consider ITU admission
21
Q

What additional management steps may be needed to treat the early complications of acute pancreatitis?

A 
Antibiotics (severe cases)
Laparotomy/debridement (abscess/pancreatic necrosis)
Urgent ERCP (gallstones)
22
Q

What is the prognosis of acute pancreatitis?

A

Unpredictable condition

  • 85% settle w/i 3-7 days
  • 15% require ICU admission (50% of these die)
23
Q

What are the potential metabolic complications of acute pancreatitis?

A

Hyperglycaemia
Hypocalcaemia
Reduced serum albumin
Malabsorption (reduced vit levels)

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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