Acute pancreatitis Flashcards
Define acute pancreatitis
Acute inflammatory process of the pancreas w/ variable involvement of other regional tissue or remote organ systems
Classification of acute pancreatitis
2
Mild: minimal organ dysfunction & uneventful recovery
Severe: organ failure &/or local complications such as necrosis, abscesses & pseudocysts
Aetiology of acute pancreatitis
Insult results in activation of pancreatic proenzymes within pancreatic duct/acini leading to tissue damage & inflammation
Causes of acute pancreatitis
11
Idiopathic Gallstones Ethanol Trauma Steroids Mumps/HIV/Coxsackie Autoimmune Scorpion venom Hypercalcaemia ERCP Drugs
Epidemiology of acute pancreatitis
prevalence, age, gender causes
COMMON
Peak age 60 yrs
Most common cause in males is alcohol & gallstones in females
Presenting symptoms of acute pancreatitis
5
Severe epigastric pain Radiating to back Relieved by sitting forward Aggravated by movement Associated w/ anorexia, N/V
Signs of acute pancreatitis on physical examination
4 + 2 severe
Epigastric tenderness
Fever
Shock
Decreased bowel sounds
In severe pancreatitis:
Cullen’s sign
Grey-Turner sign
Investigations for acute pancreatitis
5
Bloods US Erect CXR AXR CT
Investigations for acute pancreatitis - bloods
8
VERY HIGH SERUM AMYLASE High WCC U&Es - to check for dehydration High glucose High CRP Low calcium LFTs - may be deranged if gallstone pancreatitis or alcohol ABG - hypoxia or metabolic acidosis
Investigations for acute pancreatitis - US
Check for evidence of gallstones in biliary tree
Investigations for acute pancreatitis - erect CXR
2
May be pleural effusion
Check for bowel perforation
Investigations for acute pancreatitis - AXR
Exclude other causes of acute abdomen
Investigations for acute pancreatitis - CT
If diagnosis uncertain or if persisting organ failure
Management of acute pancreatitis
5
Assessment Medical ERCP & sphincterotomy Early detection & treatment of complications Surgical
Management of acute pancreatitis - assessment
2
Modified Glasgow score (combined w/ CRP >210 mg/L)
APACHE-II score
Management of acute pancreatitis - medical
6
Fluid & electrolyte resuscitation Urinary catheter & NG tube if vomiting Analgesia Blood sugar control HDU & ITU care Prophylactic antibiotics useful to reduce mortality
Management of acute pancreatitis - ERCP & sphincterotomy
3
For gallstone pancreatitis, cholangitis, jaundice or dilated CBD
Ideally performed within 72 hours
All patients presenting w/ gallstone pancreatitis should undergo definitive management of gallstones during same admission or 2 weeks
Management of acute pancreatitis - surgical
2
Necrotising pancreatitis should be managed by specialists
Necresectomy may be necessary
Types of complications of acute pancreatitis
3
Local
Systemic
Long term
Complications of acute pancreatitis - local
6
Pancreatic necrosis Pseudocyst Abscess Ascites Pseudo-aneurysm Venous thrombosis
Complications of acute pancreatitis - systemic
7
Multiorgan dysfunction Sepsis Renal failure ARDS DIC Hypocalcaemia Diabetes
Complications of acute pancreatitis - long term
1
Could result in chronic pancreatitis
Prognosis of acute pancreatitis
2
20% have severe fulminating course w/ high mortality
Infected pancreatic necrosis has 70% mortality
