Acute pancreatitis Flashcards
What is pancreatitis?
Inflammation of the pancreas
How is acute and chronic pancreatitis distinguished?
limited damage to the secretory function of the gland without gross structural damage developing
What causes acute pancreatitis?
I GET SMASHED- Idiopathic Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune (SLE) Scorpian venom, Hypercalcaemia, ERCP and drugs like NSAIDs and Diuretics
What is the pathogenesis of acute pancreatitis?
premature and exaggerated activation of digestive enzymes within the pancreas. this causes an inflammatory response, increase in vascular permeability and subsequent fluid loss into the third space, enzymes are released from the pancreas into systemic circulations causing auto digestion of fats, fat necrosis and blood vessels, free fatty acid release, serum calcium to form chalky deposits in fatty tissue, causing hypocalcaemia necrosis of the pancreas
What are the clinical features of acute pancreatitis?
Severe epigastric pain that radiates to the back and causes nausea and vomiting
What are the features of acute pancreatitis on examination?
epigastric tenderness, soft abdomen, normal bowel sounds, guarding ad rigid abdomen, circulatory instability, grey turners and cullens sign
What is Grey turners sign?
Bruising in the flanks
What is cullens sign?
Brusing around the umbilicus
What causes grey and turners sign?
retroperitoneal haemorrhage
Why may tetany occur in acute pancreatitis?
Hypocalcaemia secondary to fat necrosis and any gallstone pathology may also result in a concurrent jaundice or cholangitis
What are the differential diagnosis for acute pancreatitis?
AAA rupture, chronic pancreatitis, aortic dissection and duodenal ulcer
What are the blood tests for acute pancreatitis?
Serum amylase- x3 Upper limit, LFTs will show if cholestatic reason, serum lipase
What is the modified glasgow criteria?
severity of acute pancreatitis, look at PANCREAS- pO2, age, neutrophils, calcium, renal function, enzymes, AST, Albumin, Sugar
What is the imaging for acute pancreatitis?
abdominal ultrasound AXR can show a sentinel loop, CXR, contrast enhanced CT scan will show pancreatic oedema and swelling
What is the management for acute pancreatitis?
no cure but give oxygen, IV fluid, nasogastric tube if vomiting, catheterisation, opioid analgesia, antibiotics, cause addressed
What are the complications of acute pancreatitis?
DIC, ARDs, hypocalcaemia, hyperglycaemia, hypovolemic shock and multiorgan failure
Pancreatic necrosis and psuedocysts
What causes pancreatic necrosis?
ongoing inflammation eventually leads to ischaemic infarction of pancreatic tissue, prone to infection
How is pancreatic necrosis confirmed?
confirmed by fine needle aspiration of necrosis
What is a pancreatic pseudocyst?
collection of fluid containing pancreatic enzymes, blood, necrotic tissue usually in the lesser sac obstructing the gastro-epiploic foramen by inflammatory adhesions, lack an epithelial lining
How is a pancreatic pseudocyst treated?
Surgical debridement or endoscopic drainage
