Pancreatitis Flashcards
Pathophysiology of acute pancreatitis?
autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis
List 4 causes of pancreatitis
- Gallstones
- Alcohol
- Post-ERCP
- Trauma
List 2 drugs associated with pancreatitis
- Furosemide
- Azathioprine
- Thiazide
- Mesalazine
Pathophysiology of “Gallstone pancreatitis”
- Stones get trapped at the ampulla of vater
- Reflux of bile into the pancreatic duct and the no outflow of pancreatic juice into duodenum
- Results in inflammation in the pancreas
Pathophysiology of “alcoholic pancreatitis”
Alcohol is directly toxic to pancreatic cells, resulting in inflammation
List 4 features of acute pancreatitis
- Severe epigastric pain radiating to the back
- Vomiting
- Abdominal tenderness
- Systemically unwell (eg. low-grade fever and tachycardia).
List 2 signs on examination of pancreatitis
Cullen’s sign - Periumbilical discolouration
Grey Turner’s sign - Flank discolouration
List 4 blood Investigations for acute pancreatitis
- FBC
- U&E
- Serum amylase
- Serum lipase
List 3 imaging investigations for acute pancreatitis
- USS abdomen - to look for gallstones
- MRCP - to look for obstructive pancreatitis (ERCP is often preferred)
- CT scan for complications (ie. pseudocysts or necrotising pancreatitis)
What scoring system can be used to assess the severity of pancreatitis?
The modified Glasgow criteria:
- 0 or 1 – mild pancreatitis
- 2 – moderate pancreatitis
- 3 or more – severe pancreatitis
Management of acute pancreatitis
- ABCDE, IV fluids, Analgesia
- Careful monitoring
- Treatment of stones in gallstone pancreatitis
- Antibiotics ONLY if infection (abscess or infected necrotic area)
- Treat complications
Treatment for gallstone pancreatitis?
ERCP or cholecystectomy
Treatment for an obstructed biliary system?
ERCP
List 4 complications of acute pancreatitis
- Necrosis of the pancreas
- Infected area of necrosis
- Abscess formation
- Pseudocysts can develop ~ 4 weeks later
- Chronic pancreatitis
What is a Pseudocyst?
fluid-filled sac of pancreatic enzymes, blood and necrotic tissue which forms in the abdomen