Pancreatic Disease Flashcards
Define Acute Pancreatitis
Sudden onset inflammation of the pancreas
How does acute pancreatitis present?
- Severe Epigastric pain (may radiate to the back)
- Vomiting/Nausea
- Pyrexia
Can also cause a number of less common symptoms:
- Jaundice
- Acute Renal Failure
- Tachycardia (hypovolaemic shock)
- Retroperitoneal haemorrhage
- Effusions (Ascites/pleural)
- Paralytic Ileus
What do we call the visible signs of retroperitoneal haemorrhage in acute pancreatitis?
Grey Turner’s (on the flanks) & Cullen’s (Around the umbilicus) Signs
Both are severe bruising in the subcutaneous fat
How do we differentiate mild and severe acute pancreatitis?
Severe comes with organ failure or local complications.
Its determined by the modified glasgow criteria, if 3 or more of the criteria are +ve its severe.
A raised CRP also indicates its severe
What are the glasgow criteria for acute pancreatitis?
PANCREAS
PaO2 (<8) Age >55yrs Neutrophilia (Raised WCC) Calcium (Low) Renal Function (High Urea) Enzymes (Raised LDH and AST/ALT Ratio) Albumin (Low) Sugar (Blood Glucose raised)
What are the local complications of acute pancreatitis?
- Fluid Collection
- Pseudocysts
- Pancreatic Abscesses or necrosis
What are the common causes of acute pancreatitis?
- Alcohol abuse is the biggest
- Gallstones
- Idiopathic
Can also be blunt trauma or post-op.
Rarely drugs/viruses/pancreatic carcinoma/metabolic/auto-immune
How do gallstones cause acute pancreatitis?
They raise intra-ductal pressure preventing flow of digestive enzymes out
What blood tests do we do for pancreatic disease?
- Serum amylase/lipase (raised)
- Glucose/U&E (Raised)
- LFT (Raised AST/ALT)
- FBC (Raised WCC)
- Albumin (low)
- Ca2+ (low)
- ABG (can be low)
- Coagulation Screen
What imaging can be done for acute pancreatitis?
AXR -
CXR - Pleural Effusion
Abdominal US - Gall stones, Pseudocyst, pancreatic oedema
CT
What emergency care do we give for an acute pancreatitis case?
HDU/ITU:
- Analgesia
- IV fluids
- Transfusion (If necessary)
- Catheterise
- NG tube to maintain nutrition
- O2 (can go into resp. failure)
- Insulin
- Ca supplement
Why do we catheterize an acute pancreatitis patient?
We want to monitor urine output in order to monitor Kidney function.
acute pancreatitis can cause kidney failure which show up as small urine volume (Oliguria)
How would we treat pancreatic abscess/necrosis as a complication of acute pancreatitis?
CT guided fine needle aspiration
Then antibiotics and/or surgery as necessary
What is a pseudocyst?
A fluid collection without an epithelial lining
What would indicate presence of a pseudocyst in acute pancreatitis?
Persistantly high serum amylase and/or pain.
Diagnose with US or CT
What further problems can a pseudocyst cause?
Jaundice
Infection
Haemorrhage
Rupture
How do we treat a pseudocyst?
Endoscopic drainage or surgery if it doesnt dissapear alone
How do we treat acute pancreatitis?
- Emergency supportive care
- Treat the complications
- Treat the underlying causes (e.g. alcohol, abstinence, surgery etc)
Define Chronic Pancreatitis?
Continuing inflammatory disease of the pancreas characterized by irreversible glandular destruction and typically causing pain and/or impairment of function
What causes Chronic Pancreatitis?
O-A-TIGER Obstruction - Main Pancreatic duct e.g. Cystic Fibrosis Autoimmune Toxin - Alcohol is the biggest cause of CP Idiopathic Genetic Environmental Recurrent injury
Also can be a congenital anatomical abnormality such as annular pancreas divisum where the ventral/dorsal pancreatic buds fail to fuse