Acute pancreatitis Flashcards
How can acute pancreatitis be distinguished from chronic?
Limited damage to secretory function
What are the causes of Acute pancreatitis?
- I GET SMASHED
- Idiopathic
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune disease (SLE)
- Scorpion venom
- Hypercalcaemia
- ERCP
- Drugs
What drugs can cause acute pancreatitis?
- NSAIDs
- Azathioprine
- Diuretics
- Steroids
Describe the pathogenesis of acute pancreatitis?
- Premature and excess digestive enzyme release
- Inflammatory response causes increased vascular permeability and fluid loss
- Enzymes cause autodigestion of fats and blood vessels
- FFAs then react with calcium causing chalky deposits and hypocalcaemia
What are the features of Acute pancreatitis?
- Epigastric pain -> back
- Vomiting
- Tenderness, ileus and low grade fever
- Cullens and grey turners sign
What is cullens sign?
- Periumbilical discolouration
- Present in ectopic pregnancy and acute pancreatitis
What is grey turners sign?
- Flank bruising / discolouration
- Can predict a severe attack of acute pancreatitis
What are the invesitgations for acute pancreatits?
Raised serum amylase
Name a scoring system for pancreatitis?
Glasgow scale of pancreatitis severeity (PANCREAS)
Features of the Glasgow scale of pancreatitis severity?
- PANCREAS
- PaO2 <7.9
- Age >55
- Neutrophils (WBC >15)
- Calcium (hypocalcaemia)
- Renal function (Urea > 16)
- Enzymes LDH > 600
- Albumin <32
- Sugar (blood glucose > 10)
- More than 3 features indicates severe pancreatitis
Differentials for acute pancreatitis?
- Sympatomatic/ruptured AAA
- Chronic pancreatitis
- Aortic dissection
- Duodenal ulcer
What investigations should be performed for someone with a suspected acute pancreatitis?
- Serum amylase (3x upper limit of normal)
- LFTs (ALT>150 predicts gallstones are the cause)
- Serum lipase (raised)
- Imaging
- Abdo US
- Contrast-enhanced CT
What other factors can cause a raised serum amylase?
- Bowel perforation
- Ectopic pregnancy
- Mesenteric ischaemia
- DKA
Describe risk scoring for Acute pancreatitis?
- Modified Glasgow Criteria
- Assesses severity within 48hours of admission
- PANCREAS
- pO2<8kPa
- Age>55
- Neutrophils: WCC>15x109/L
- Calcium <2mmol/L
- Renal function: Urea >16mmol/L
- Enzymes: LDH>600U/L
- Albumin <32g/L
- Sugar: glucose >10mmol/L
Describe the use of abdominal ultrasound for acute pancreatitis?
- If underlying cause is unknown
- Identifies gallstones through dilation of bile ducts
Describe the use of AXR in diagnosing acute pancreatitis?
- Not routinely performed
- Can show sentinal loop sign
- Dilated proximal bowel loop adjacent to pancreas
- Secondary to localised inflammation
Describe the use of a contrast-enhanced CT scan in the diagnosis of acute pancreatitis?
- Performed within 48hrs of presentation if bloods are inconclusive
- Can show areas of pancreatic oedema and necrosis
Describe the managment of Acute pancreatitis?
- Most people settle with supportive treatments
- Oxygen, fluids
- NG tube if vomiting, opioid analgesia
- Treat underlying cause
- Gallstones
- ERCP, sphincterotomy
- Gallstones
What are the systemic complications of Acute pancreatitis?
- Disseminated intravascular coagulation (DIC)
- ARDS
- Hypocalcaemia
- Hyperglycaemia
What are the local complications of Acute pancreatitis?
- Pancreatic necrosis
- Pancreatic pseudocyst
Describe pancreatic necrosis as a complication of acute pancreatitis?
- Suspect in patients with persistent systemic inflammation >7 days
- Confirmed by CT scan
- Fine needle aspiration of the necrosis if infection develops
Describe a pancreatic pseudocyst as a complication of acute pancreatitis?
- Collection of fluid containg enzymes, blood and necrotic tissue
- Usually seen in the lesser sac
- Best visualised using MRI
- Treatment with surgical debridement or endoscopic drainage into stomach
What are the two different functions of the pancreas?
- Endocrine
- Exocrine
Describe the exocrine function of the pancreas?
- Digestion of fats, protein asnd carbohydrate
- 1L of alkaline enzymne-rich fluid is produced every day
- Trypsin, lipase and amylase
Describe the endocrine function of the pancreas?
- Islets of langerhans
- α cells - glucagon
- β cells - insulin
- D cells - somatostatin
- PP cells - pancreatic polypeptide
What is ileus?
- Lack of movement of somewhere in the intestine
- Leads to build up and potential blockage
Describe the symptomatic stratification of mild acute pancreatitis?
- No organ failure
- No local or systemic complications
Describe the symptomatic stratification of moderately severe acute pancreatitis?
- Organ failure which resolves wtihin 48 hours and/or
- Local or systemic complications without persistent organ failure
Describe the symptomatic stratification of severe acute pancreatitis?
- Persistent organ failure > 48 hours
- Single organ failure
- Multiple organ failure
Label the pancreas
Describe the blood supply of the pancreas?
- Pancreatic branches of the splenic artery
- Head is additionally supplied by the superior and inferior pancreaticoduodenal arteries
- Superior pancreaticoduodenal is from coeliac trunk
- Inferior pancreaticoduodenal is from the superior mesenteric arteries
Describe the venous drainage of the pancreas?
- Head of pancreas
- Superior mesenteric branches of the hepatic portal vein
- Rest of the pancreas
- Pancreatic veins to splenic veins
What regions of the abdomen does the pancreas lie in?
Epigastric and left hypochondrium
What is the only part of the pancreas that is intraperitoneal?
Tail
