Pancreatis Flashcards
Cause of Acute pancreatis
Gall stones Ethanol Trauma, Tumour Steroids Mumps Autoimmune Scorpion venom Hyperlidiaemia Hypothermia Hypercalcaemia ERCP and EMboli Drugs Also: pregnancy, neoplasia or no cause found.
Symptoms of acute pancreatis
Gradual or sudden severe epigastric pain that radiates to the back, relieved by sitting forward
Prominent vomiting
Hx of alcohol, gallstones (cholelithiasis.
Mx of acute pancreatis
Nil by mouth
ABCD
2 large bore cannulas
Support care - fluids, Urinary catheter, Analgesia, insulin, NGT
Hourly observations
Daily blood - FBC, U and E, Ca, glucose, amylase, ABG
If worsen think abscess or necrosis, may need surgery to debridge necrosis. Remove any gallstone if that is the cause. Abx
Signs of acute pancreatitis
GI - Jaundice, anxious and distressed in pain, may be sitting forward.
Vital - fever, tachycardia, tachypnoea, hypotension, Trouseau’s sign.
Hands - Parasthesia and numbness of fingertips (hypocalcemia = neuromuscular irriability)
Face - Scleral icterus, Chvostek’s sign,
Abdo - I - distension (ileus), Cullen’s sign, grey turner’s sign, P - epigastric pain, rigidity, local or generalised tenderness, Pseudocyst, liver and spleen, A - absent bowel sounds(paralytic ileus)
Symptoms of chronic pancreatitis
Hallmark - epigastric pain, radiating to back, dminished by sitting forward, worse 30min after eating, steatorrhoea, malnutrition, DM, may be jaundice
2/3 cases associated with chronic alcoholism and smoking.
Malabsorption
Low albumin
Wt loss
Pleural effusion
Increase risk of pancreatic cancer
Signs of chronic pancreatitis
GI - sitting forward, jaundice, cachectic due to malabsorption, DM, Skin nodules (lipase may leak into circulation fat necrosis), diaphoresis.
Vital - fever, tachycardia, tachypnea, reduce BMI
Hands - Skin nodules, polyarthritis,
Face - scleral icterus
Neck - palpate carotid arteries for pulse volume and character
Chest - Pleural effusion
Abdo - Distension, Pseudocyst (tense, don’t descend with inspiration and feels fixed), pancreatic ascites, obstruction, pancreatic cancer, epigastric pain on palpation, hepatomegaly.
Severity of pancreatitis
Modified Glasgow criteria
PaO2 less than 60mmHg
Age greater than 55yrs
Neutrophilia with WBC greater then 15
Calcium less then 2mmol/L
Renal function urea greater then 16mmol/L
Enzymes LHD greater then 600 and AST greater then 200
Albumin less then 32g/L
Sugar blood glucose greater then 10mmol/L
3 or more within 48hr indicates a need for HDU.
Ranson’s criteria for pancreatitis mortality
On admission - WBC greater then 16 - Age greater then 55yr - Glucose greater then 10 - AST greater then 250 - LDH greater then 350 48 hours into admission - HCT drop by more then 10% - BUN increase by greater then 1.79mmol/L - Ca less then 2 mmol/L - Arterial pO2 less then 60mmHg - Base deficit greater then 4 with HCO3 of 24 - Fluid needs greater then 6L Score 0 to 2 gives 2% mortality 3 to 4 gives 15% mortality 5 to 6 gives 40% mortality 7 to 8 gives 100% mortality
Ix for pancreatitis
Lipase, FBC, U and E, ABG, CMP, Abdo Xray, LFT
In chronic - CT scan - calcification, Faecal pancreatic elastase
Cx for pancreatitis
Early - shock, ARDS, renal failure, DIC, sepsis, hypocalceamia, increase glucose
Late - pancreatic necrosis, pseudocyst, Abscess, bleeding, Thrombosis, Fistulae,
Tx of pancreatis
Surgical and ICU consult FLuid management Analgesia O2 if needed IV cannula NBM ABX if secondary infection Tx underlying cause Hourly observation Daily bloods
