Pancreatic Disorders Flashcards
Acute pancreatitis
An acute inflammatory disorder of the pancreas that is characterized by edema and severe necrosis
Chronic pancreatitis
A progressive chronic inflammatory disease which there is irreversible destruction of pancreatic tissue.
Etiologies of acute pancreatitis?
( Get 3I)
1. Migrating GB stones ( 50 % biliary pancreatitis)
2. Excess alcohol intake (35%)
3. Trauma e.g. ERCP is the third common cause, operation or accident.
4. Infection e.g. mumps or influenza.
5. Vascular insufficiency = infarction of pancreas = release of enzymes
6. Idiopathic with no detectable cause
7. Rarely autoimmune, hyperparathyroidism and corticosteroids.
Patho physiology of acute pancreatitis?
Gallstones pancreatitis
Gallstone obstructing the CBC ( ampulla of vater) = back up of the pancreatic enzymes = increase pressure = premature activation of pancreatic enzymes within the duct system.
Alcohol = damage cells of pancreas ( acinar cells ) , pancreatic duct cells, occlusion of p. Duct = activation of enzymes
- when the pancreas is inflamed leads to “ digestion “ of the pancreas by its own enzymes and / or irreversible damage to the organ
Patho physiology of chronic pancreatitis?
Long term abuse of alcohol intake = recurrent inflammation damages the structure pancreas
- Cystic fibrosis ( lack CFTR protein ) = Plays a role in the movement of chloride ions to help balance salts and water in Epithleial cells that line pancreatic duct .
Decrease bile production = thick mucous in pancreatic ducts = blockage = digestive enzymes activate = damage pancreas .
End result = pancreas experiences fibrosis = no longer produce enzymes
Diagnosis
Blood test: Amylase, Lipase , high electrolytes
CT scan / ulterasoud
ERCP ( asses pancreas, bile ducts, gallbladder, w/scope. Remove gallstone, dilute block duct, drain ducts w/ ballon. / stent .
S/ S of acute Pancreatitis
Sudden, very painful mid epigastric pain of LUA radiate to the back. Hurt when lying back
Pain come on after drinking alcohol
Fever, increase HR , decrease blood pressure.
Increase glucose, increase amylase and lipase
Cullen s sign = bluish discoloration umbilicus ( circle )
Grey turner sign = bluish discoloration ( Turn her over )
S/ S of chronic Pancreatitis
Chronic mid-epigastric pain ( may or may not have have pain after alcohol intake ) * Pain if the acinar cells damaged completely.
- may have swelling or mass abdomen “ pseudo cyst “
- Steatorrhea : diarrhea of oil / greasy stools ( decrease pancreatic enzymes)
- weight loss ; don’t digest food properly
Jaundice:
Dark urin; excess bile in the body
DM: damaged islets of langerhans
Causes of raised serum amylase level other than acute pancreatitis?
- Upper GIT tract perforation
- Mesenteric infarction
- Torsion of an intra - abdominal viscus
- Retroperitoneal hematoma
- Renal failure
- Salivary gland inflammation
Assessment of severity
Revised Atlanta Criteria ( 2013 )
1. Mild acute pancreatitis
- Absence of organ failure
- Absence of local complications
2. Moderately sever acute pancreatitis
- Local complications
- Transient organ failure < 48 h
3. Severe acute pancreatitis
- Persistent organ failure > 48 h
Most widely used for assessment of severity of pancreatitis ?
BISAP score
Management ( intitial assessment and risk stratification ( first 4 hrs ) )
- Fluid resuscitation ( Aggressive hydration (250 – 500 ml / hour) of isotonic crystalloid solution should be provided to all patient )
- Oxygenation
- Analgesia : Morphine is to be avoided because of its potential to cause sphincter of Oddi spasm.
- Predict severity of pancreatitis
Patients with organ failure should be admitted to an intensive care unit
Reassessment / management ( 4 to 6 hrs )
- Assess response to fluid resuscitation (every 6 h for the first 24 – 48 h)
- Patients with acute pancreatitis and concurrent acute cholangitis should undergo ERCP within 24 h of admission
- No prophylactic antibiotics
- Antibiotics are always recommended to treat infected necrosis.
- In mild AP, enteral nutrition once normovolemia restored if no gastric stasis with a low-fat solid diet
- In severe AP, enteral nutrition (Nasogastric delivery and nasojejunal) is recommended to prevent infectious complications.
Complications of acute pancreatitis
- local
Pancreatic phlegmon
Pancreatic abscess
Pancreatic pseudocys
Pancreatic ascites
Involvement of adjacent organs, with hemorrhage, thrombosis, bowel infarction or fistula formation
Systemic
A. Polumnary:
- Pneumonia, atelectasis
- Acute respiratory distress syndrome.
- Pleural effusion
B. Cardiovascular
- Hypotension
- Hypovolemia
- Arrhythmia
- Pericardial effusion
Gastrointestinal
- Ileus
- Portal vein or splenic thrombosis with varies
Metabolic
- Hyperglycemia
- Hypocalcemia
- Hyperlipidemia
Fat necrosis
- intra abdominal saponification
- subcutaneous tissue necrosis
The role of surgery in Acute Pancreatits
Cullen’s sign
Grey turner sign
