Pancreatitis Flashcards
What is pancreatitis?
Inflammation of the pancreas
What parts of the pancreas are retroperitoneal?
Head, neck, and body
What parts of the pancreas are intraperitoneal?
Tail
What are the signs and symptoms of pancreatitis?
Severe upper abdominal (left upper quadrant) pain, radiating to the back Nausea, vomiting (worse with eating) Fever Tachycardia Fatty stool (Steatorrhea)
What are the complications following pancreatitis?
Shock
Widespread infection
Ascites, kidney failure
What is pancreatitis caused by?
Eighty percent of cases of pancreatitis are caused by alcohol or gallstones.
Gallstones most likely to cause acute pancreatitis
Alcohol –> chronic pancreatitis
Metabolic causes such as hypercalcaemia or hyperlipidaemia
What (seven) medications are associated with pancreatitis?
Statins ACE inhibitors Oral contraceptives/hormone replacement therapy (HRT), Diuretics Antiretroviral therapy Valproic acid Oral hypoglycemic agents
How is pancreatitis diagnosed?
Diagnosis requires 2 of the 3 following criteria:
- Acute onset of epigastric pain
- Serum amylase or lipase levels ≥ 3 times the upper limit of normal
- An imaging study with characteristic changes. CT, MRI, abdominal ultrasound or endoscopic ultrasound can be used for diagnosis.
What are differential diagnoses for pancreatitis?
Cholecystitis, choledocholithiasis, perforated peptic ulcer, bowel infarction, small bowel obstruction, hepatitis, and mesenteric ischemia
What is a test marker for chronic pancreatitis?
Fecal pancreatic elastase-1 (FPE-1): a marker of exocrine pancreatic function
How would you manage mild acute pancreatitis?
The treatment of pancreatitis is supportive and depends on severity. Morphine generally is suitable for pain control
When the pancreatitis is due to gallstones, early gallbladder removal also appears to improve outcomes
How would you manage severe acute pancreatitis?
Severe pancreatitis can cause organ failure, necrosis, infected necrosis, pseudocyst, and abscess
Fluid resuscitation
Treat underlying cause
Restrict fat intake
What is the APACHE II score?
A severity-of-disease classification system used within 24 hours of ICU admission
Why is the APACHE II score helpful?
This scoring system is used in many ways which include:
- Some procedures or some medicine is only given to patients with a certain APACHE II score
- APACHE II score can be used to describe the morbidity of a patient when comparing the outcome with other patients.
- Predicted mortalities are averaged for groups of patients in order to specify the group’s morbidity.
How would you calculate someone’s APACHE II score?
The point score is calculated from 12 admission physiologic variables comprising the Acute Physiology Score, the patient’s age, and chronic health status
