Acute Pancreatitis Flashcards
1
Q
pathophysiology?
A
inflammation of exocrine pancreas due to auto-digestion by its own enzymes
2
Q
Aetiology? mnemonic
A
Gallstones
Ethanol
Trauma
Scorpion poison (of trinidadian scorpion bite)
Mumps
Auto-immune
Steroids
Hyperlipidaemia, hypercalcaemia
ERCP
Drugs ie azathioprine
3
Q
classification?
A
Glasgow score: Mild (<2), moderate (2) or severe (>2)
-each one below counts for 1
Pa02<60
Age > 55
Neutrophils: WBC > 15
Calcium < 2mmol/l
uRea >16
Enzymes: LDH>600 or AST/ALT>200
Albumin <32
Sugar (glucose >10)
4
Q
symptoms?
A
- severe epigastric pain, often radiating to back
- vomiting & retching
- fever
- tachycardia
5
Q
signs?
A
- profound shock
- guarding / rigidity of abdo
- may be obstructive jaundice
- cbd stones
- oedema of head of pancreas
- reduced bowel sounds
- ecchymotic bruising & discolouration in complicated haemorrhagic pancreatitis
- peri-umbilical skin- cullen’s sign
- around both flanks- grey turner’s sign
6
Q
Ix?
A
- Bloods
- amylase /lipase (>3x upper limit of normal)
- lipase preferable to amylase
- FBC, CRP, UE, LFT, calcium
- amylase /lipase (>3x upper limit of normal)
- ABG
- CXR
- AXR
- sentinel loop, colon cut off sign
- Trans-abdominal USS
7
Q
what investigation would u do if diagnosis unclear within 24h?
A
CT abdo
8
Q
what must be noted about lipase levels in diabetics?
A
they have higher median lipase levels
9
Q
Mx?
A
- Analgesia
- ERCP if gallstones/cholangitis in SEVERE + system support ie ventilation, inotropes, renal dialysis
- IV fluids
- Oxygen
- Urinary catheter & nutritional support - fluid balance
Abx ONLY IF SEPSIS
10
Q
systemic complications
A
- shock
- ARDS
- acute renal failure
- DIC
- hypocalcaemia / hyperglycaemia
- ileus
11
Q
local complications?
A
- pancreatic abscess
- sterile / infected pancreatic necrosis
- pseudocyst
- acute fluid collection
12
Q
DDx?
A
- AAA
- mesenteric infarction
- MI
- perforated duodenal ulcer
- cholecystitis / cholangitis
