Acute pancreatitis Flashcards
What is acute pancreatitis?
Acute inflammatory process of pancreas, with variable involvement of regional/remote tissue
What is the pathology of acute pancreatitis?
Autodigestion of pancreatic tissue by enzymes –> inflammation
What are the classifications of acute pancreatitis?
Mild= mild interstitial oedema of gland, no organ failure/complications Moderate= organ failure that resolves within 48 hours +/- systemic complications without persistent organ failure Severe= Pancreatic necrosis, acute fluid collection or organ failure >48 hours
What are the common causes of acute pancreatitis?
Idiopathic/iatrogenic
Gallstones
Ethanol- main cause
Trauma
What are the less common causes of acute pancreatitis?
Steroids Mumps Autoimmune Scorpion venom Hyperlipidaemia ERCP Drugs
What are the features of acute pancreatitis?
Severe epigastric pain- can radiate to back, reaches maximum over a number of hours Vomiting, anorexia Pyrexia, tachycardia Hypovolaemia Jaundice Ileus Discolouration of skin
What investigations should be done for acute pancreatitis?
Bloods AXR Erect CXR Abdo US COntrast CT
What bloods should be done for acute pancreatitis?
Amylase Lipase FBC, U&E, LFTs, Ca, lipids Coag screen Glucose ABG if unwell
What scoring system is used for pancreatitis?
Modified Glasgow score
>3= severe pancreatitis
What is the modified Glasgow score?
PANCREAS PaO2 <8 Age >55 Neutrophilia Calcium low Renal impairment- urea high Enzymes raised- AST, ALT, LDH Albumin low Sugar high
How is acute pancreatitis diagnosed?
2 of
- abdo pain consistent with acute pancreatitis
- serum amylase >3x upper limit of normal
- characteristic CT findings
What are the differentials for acute pancreatitis?
Perforated ulcer Acute cholecystitis Intestinal obstruction Mesenteric ischaemia MI AAA
What is the management of mild acute pancreatitis?
Monitoring- NEWS and urine output
Supportive
What is the management of severe pancreatitis?
HDU/ITU admission Monitoring- inc urine output Supportive Antibiotics CT after 3-10 days
What is the management of pancreatic necrosis?
Non infected= conservative
Infected= necrosectomy
How can non infected pancreatic necrosis be differentiated from infective?
Free air on CT
Wha are the local complications of acute acreatitis?
Acute fluid collection Acute pseudocyst Chronic pseudocyst Abscess Pancreatic necrosis
What are the systemic complications of acute pancreatitis?
Shock Sepsis DIC AKI Hyperglycaemia ARDS Organ failure
What can cause high amylase?
PAncreatitis- acute or chronic Gallstones Pancreatic trauma Kidney failure Liver failure Peritonitis PArotitis Chronic alcoholism
