Acute pancreatitis Flashcards
1
Q
Define
A
Acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems
2
Q
Aetiology/Risk factors
A
Insult results in activation of pancreatic proenzymes within the duct/acini resulting in tissue damage and inflammation
Most common: Gallstones, alcohol (80% of cases)
I GET SMASHED
3
Q
Epidemeology
A
- Common
- Peak age is 60 yrs
- Alcohol induced in more common in males while in females, principle cause is gallstones
4
Q
Investigations
A
- Blood: Increased Amylase, FBC (Increased WCC), U&E’s, Raised glucose, CRP, Decreased Ca + increased PT
- USS: for gallstones or biliary dilatation
- Erect CXR: May be pleural effusion, mainly for excluding other causes
- AXR: To exclude other causes of acute abdomen. Psoas shadow may be lost
- CT
- ABG to check for ARDS
5
Q
Symptoms
A
Severe dull boring epigastric or abdominal pain (radiating to back, relieved by sitting forward, aggravated by movement)
- Associated with anorexia, nausea and vomiting
- May be history of gallstones or alcohol intake
6
Q
Signs
A
- Epigastric tenderness, fever
- Shock, tachycardia, tachypnoea
- Reduced bowel sounds (due to ileus)
- If severe and haemorrhagic, Turner’s sign (flank bruising) or Cullen’s sign (periumbilical bruising)
7
Q
Management
A
- Medical: Fluid and electrolyte resuscitation, urinary catheter and NG tube if vomiting. Analgesia and blood sugar control
- ERCP and sphincterotomy
- Surgiccal: patient with necrotizing pancreatitis should be managed in a specialist unit
8
Q
Complications
A
- Local: pancreatic necrosis, pseudocyst, abscess, ascites, pseudoaneurysm or venous thrombosis
- Systemic: Multiorgan dysfunction, sepsis, renal failure, ARDS< DIC, hypocalcemia, diabetes
- Long term: Chronic pancreatitis
9
Q
Prognosis
A
20% follow severe fulminating course with high mortality (infected pancreatic necrosis associated with 70% mortality)
