Acute Pancreatitis Flashcards
What is acute pancreatitis?
pancreatic inflammation due to autodigestion
What percent is self-limiting?
90%
10-15% become ______
chronic
Where does pancreatic enzymes normally get activated? By what two components?
pancreatic juices move into the duodenum where pancreatic enzymes get activated by BILE and TRYPSIN
Is it potentially fatal?
yes
How does autodigestion occur?
Autodigestion occur when bile flow outside the duodenum and combines with pancreatic juice activating the digestive enzymes prematurely.
–> activated enzymes break down structure proteins of the pancreas causing self-breakdown and self-digestion
Pancreatic enzymes are secreted in an ______ form
inactive
Etiology (5)
- alcohol abuse (~70%)
- idiopathic (~10%)
- stones eg gallstones
- injury eg physical trauma or infection
- drugs (inflict injury to pancreas)
Pathophysiology: Gallstones
stone obstruct the bile flow causing bile stasis or reflux of bile–> bile flows backwards into ducts and pancreas causing premature activation of enzymes –> prematurely activated enzymes break down structure protein = AUTODIGESTION–> followed by inflm, hemorrhage, and necrosis
Why does hemorrhage occur?
blood vessels can be damaged
Pathophysiology: alcohol (2 ways)
- alcohol constricts the Sphincter of Oddi:
- pancreatic juice cannot enter into duodenum resulting in accum of bile and pancreatic secretion into common bile duct and pancreatic duct and into the pancreas where enzyme get activated prematurely - alcohol increases pancreatic secretion:
- fills up the ducts and back up into the pancreas
- the constriction of the Sphincter of Oddi causes bile and pancreatic secretion to back into ducts and into pancreas where enzymes are activated prematurely
Manifestations
- acute onset
- excessive third spacing
- many others: tachycardia, fever, resp distress
Complications
vascular collapse and shock
b/c there are not enough blood in blood vessels
What triggers acute onset? Where is the severe pain located and where does it radiates?
- acute onset follows alcohol binge and after a large meal
- epigastric and periumbilical region
- radiates to back, chest, and flank
Why does pain follow after alcohol binge and large meal (3)?
- incr. secretion of dig. enzymes
- incr. pancreatic secretions
- incr. bile production
Why does excessive 3rd spacing occur?
pancreas is richly vascularized–> inflm leads to hyperemia–> exudate produced –> incr. CHP –> fluid from vessels to interstitial space of pancreas (cavity of pancreas)
What are the complication of 3rd spacing?
removing fluid from vasculature can lead to hypovolemia, hypovolemic shock, and vascular collapse
Is fever, tachycardia, and respiratory distress linked to pancreas? Fever?
not obviously linked to pancreas but can be present
fever occurs w/ or w/o infection
Diagnosis (labs, biomakers, and imaging).
- labs: amylase and lipase–> incr. when pancreas is damaged
- new biomakers: TNF, trypsinogen, and proteases–> decr. levels = recovery is occurring
- U/S and CT scan to determine swelling of pancreas
What diagnostic testing reveal more information on severity, sensitivity, and prognosis of acute pancreatitis? New or old?
biomakers: TNF, trypsinogen, and proteases
New.
What is TNF
tumor necrosis factor: cytotoxin are proteins that are found in blood d/t cell death
What are trypsinogen?
precursor of trypsin (dig. enzymes) that is activated in intestinal mucosa
What are proteases?
enzymes found in pancreas that break down proteins
What diagnostic testing do not give prognosis or severity of diease?
amylase and lipase–> degree of elevation is not related to degree of damage
treatment for mild form (4)
- one week recovery
- NPO b/c ingestion incr. pancreatic secretion and bile
- manage pain
- correct fluid and electrolyte imbalance
treatment for severe form
- patient req ICU
- IV opiates
- sx: depending on circumstances eg gallstones
leads to systemic issues:
- renal prob: hypovolemia affects perfusion of kidneys resulting in decr. fxn and fluid imbalance
- circulatory: hypovolemia + hypovolemic shock
- hepatobiliary: gallbladder and liver are affected (b/c all ducts are joined together)
- pulmonary: a complication of acute pancreatitis is acute respiratory distress syndrome (ARDs)
