Pancreaatobiliary emergencies: acute pancreatitis Flashcards
What is the diagnosis of acute pancreatitis based on
The characteristic abdominal pain and nausea combined with elevated serum levels of pancreatic enzymes
What must be given immediately in acute pancreatitis
Fluid resuscitation
What has caused an increase in emergencies recently
The increase in alcohol consumption
The better diagnostic capability
What is the mortality rate in patients with acute pancreatitis
5%
What does the pathological process involve in acute pancreatitis
Inflammation
oedema
necrosis of pancreatic tissue
What is the mneumonic for the causes of acute pancreatitis
Gall stones Ethanol Trauma Steroids Mumps Autoimmune Spider bites/ scorpion bites Hypertriglyceridaemia, hypercalcaecmia ERCP Drugs
What might cause premature activation of pancreatic enzymes
Obstruction by protein plugs
What is pancreas divisum
Where there is failure of the dorsal and ventral ducts to fuse in the embryo so that most of the pancreatic juice flows through the minor pancreatic duct and papilla
What happens when the pancreas becomes inflamed
Activation of pancreatic enzymes within the gland itself
What do the pancreatic enzymes do
Damage tissue
activating complement and the inflammatory cascade and produce cytokines
What 3 things can occur as a result of a systemic inflammatory response
Respiratory distress syndrome
Cardiovascular failure
renal failure
What is the main result of acute pancreatitis
A chemical burn - activated enzymes and cytokines enter the peritoneal cavity resulting in capillary leakage of pancreatic fluid
What are pseudocysts
Collections of pancreatic fluid and tissue debris formed around the pancreas surrounded by a fibrous lined capsule (not epithelial)
What are 3 metabolic complications of pancreatitis
Hypocalcaemia
Hypomagnesaemia
hyperglycaemia
What might become infected in pancreatitis
The pancreatic pseudocysts of the necrotic tissue by enteric bacteria
In what region is pancreatic pain found
Epigastric
Where does pancreatic pain radiate to
The back (50% of patients)
What might reduce the pain
Sitting up and leaning forwar
What might accentuate the pain
Coughing
Vigorous movement
Deep breathing
What are 2 other common presentations
Nausea and vomiting
What might be heard on a respiratory examination of a patient with pancreatitis
Basal crackles consistent with atalectasis
What is Grey- Turner’s sign
Blue-grey discolouration of the flanks due to exudation of fluid sustained by pancreatic necrosis into the subcutaneous tissue
What is the Cullen’s sign
Discolouration in the periumbilical area
What might the bowel sounds be liek in pancreatitis
Hypoactive
What might reduce the pain
Sitting up and leaning forward
What might the bowel sounds be like in pancreatitis
Hypoactive
How is the severity of acute pancreatitis defined
The presence or absence of organ failure, local complications or both
What is the scoring system used in pancreatitis
Ranson criteria
When is the Ranson criteria completed
48 h after onset of the episode
What are some clinical findings that indicate severe disease
Thirst poor urine output pregressive tachycardia tachypnoea hypoxaemia agitation confusion rising haematocrit level lack of improvement in symptoms
What is the most widely available test for pancreatitis
Serum amylase
Lipase
What should all patients have following a thorough history and physical examination
Serum amylase (and lipase if available) FBC U&E Coagulation screening LFT Serum alctate Calcium, magnesium Glucose ABG Biliary ultrasonography
What are some of the follow up investigations
Fasting plasma lipids and calcium
repeat biliary ultrasonography
What must be excluded from the differential diagnosis in recurrent idiopathic acute pancreatitis
Pancreatic cancer
microlithiasis
chronic pancreatitis
pancreas divisum
What analgesia should be given
Opiate
What opiate should be avoided and why
Morphine - it might exacerbate pancreatitis by increasing sphincter of Oddi tone
What nutritional support should be the goal for all patients with acute pancreatitis
Enteral
