Acute Pancreatitis PASSMED Flashcards
What is acute pancreatitis usually due to?
Acute pancreatitis is usually due to alcohol or gallstones.
What is the pathophysiology of acute pancreatitis?
Autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis.
What are the common features of acute pancreatitis?
Severe epigastric pain that may radiate to the back, vomiting, epigastric tenderness, ileus, and low-grade fever.
What are Cullen’s sign and Grey-Turner’s sign?
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) are described but rare.
What is a rare feature associated with pancreatitis?
Ischaemic (Purtscher) retinopathy, which may cause temporary or permanent blindness.
What investigations are used for acute pancreatitis?
Serum amylase and serum lipase.
What is the significance of serum amylase in acute pancreatitis?
Raised in 75% of patients, typically > 3 times the upper limit of normal; specificity for pancreatitis is around 90%.
What are other causes of raised amylase?
Pancreatic pseudocyst, mesenteric infarct, perforated viscus, acute cholecystitis, diabetic ketoacidosis.
Why is serum lipase preferred over serum amylase?
More sensitive and specific than serum amylase; has a longer half-life and may be useful for late presentations > 24 hours.
How can a diagnosis of acute pancreatitis be made?
A diagnosis can be made without imaging if characteristic pain + amylase/lipase > 3 times normal level.
What is the importance of early ultrasound imaging in acute pancreatitis?
Important to assess the aetiology as this may affect management, e.g., patients with gallstones/biliary obstruction.
What are some scoring systems used for severe pancreatitis?
Ranson score, Glasgow score, and APACHE II.
What are common factors indicating severe pancreatitis?
Age > 55 years, hypocalcaemia, hyperglycaemia, hypoxia, neutrophilia, elevated LDH and AST.
Is the actual amylase level of prognostic value?
No, the actual amylase level is not of prognostic value.
