Pancreatitis Flashcards
What is pancreatitis?
Inflammation of the pancreas
What are the 2 forms of pancreatitis?
Acute and Chronic
What is acute pancreatitis?
Rapid onset of inflammation and symptoms
What is chronic pancreatitis?
Long term inflammation and symptoms
What is the outcome of acute pancreatitis?
Eventually resolves
What is the outcome of chronic pancreatitis?
Progressive and permanent
What are the 3 main causes of pancreatitis?
Gall stones
Alcohol
Post-ERCP
Who do gallstones tend to occur in?
Women and older people
Who tends to develop alcohol induced pancreatitis?
Men and younger people
What is the pneumonic for the other causes of pancreatitis?
I GET SMASHED
What does I GET SMASHED stand for?
I- Idiopathic G- Gallstones E- Ethanol T- Trauma S- Steroids M- Mumps A- Autoimmune S-Scorpion sting H- Hyperlipidaemia E- ERCP D- Drugs
How does pancreatitis present?
Severe epigastric pain- radiates to back
Vomiting
Abdominal tenderness
Systemically unwell
Which drugs can cause pancreatitis?
Thiazide
Furosemide
Diuretics
How can the pain be relieved in someone with pancreatitis?
By leaning forward or lying in fetal position
What is the main diagnosis for Pancreatitis?
Lipase- more specific than amylase
What other investigations are carried out for pancreatitis?
Amylase
C-reactive protein
Ultrasound
CT abdomen
What will the level of amylase be in someone with Pancreatitis?
Three times the normal level
What does c-reactive protein suggest?
Inflammation
What would you see with an ultrasound in someone with pancreatitis?
Gallstones
Why would you do a CT abdomen in someone with pancreatitis?
To look for complications
How is the severity of Pancreatitis assessed?
Glasgow score
What is the pneumonic for the Glasgow score?
PANCREAS
What does PANCREAS stand for?
P- Pa02 <60mmHg A- Age >55 N- Neutrophilia (WBC)>15 C- Calcium <2mmol/L R- Renal function-Urea >16mmol/L E- Enzymes- LDH >600iU/L AST>2000iU/L A- Albumin <32g/L S- Sugar- Glucose >10mmol/L
What is the management of Acute Pancreatitis?
Initial resuscitation
IV fluids
Analgesia
If gallstones- ERCP or Cholecystectomy
What are possible complications of Acute Pancreatitis?
Necrosis of the pancreas
Infection in a necrotic area
Abscess formation
Pseudocysts
When do pseudocysts tend to form after pancreatitis?
4 weeks after
What does chronic pancreatitis result in?
Fibrosis and reduced function of the pancreatic tissue
What is the commonest cause of chronic pancreatitis?
Alcohol
How long do the symptoms in chronic pancreatitis last?
Longer than in acute pancreatitis
What are the main complications of chronic pancreatitis?
Chronic epigastric pain
Exocrine function affected
Endocrine function affected
Damage and strictures in the duct system
How is the endocrine function affected in chronic pancreatitis?
Lack of insulin leading to diabetes
How is the exocrine function affected in chronic pancreatitis?
Lack of pancreatic enzymes into GI tract
What does damage and strictures lead to due to chronic pancreatitis?
Obstruction
What is the lifestyle management of chronic pancreatitis?
Abstinence from alcohol and smoking
What is the medical management of chronic pancreatitis?
Pain- Analgesia
Replacement of pancreatic enzymes
Diabetes- Subcutaneous insulin
Obstruction- ERCP with stenting
What in the history might indicate acute pancreatitis?
Recent alcohol binge or gallstones
What can be seen on examination that is highly indicative of pancreatitis?
Cullen’s sign
What is cullen’s sign?
Bruising around the peri-umbilical area which again is highly associated with pancreatitis.
When is the Glasgow score calculated in someone presenting with pancreaitis?
On admission and after 48 hours of admission
What would a Glasgow score of more than 3 suggest?
A score of 3 or more positive factors indicates transfer to ITU/HDU for intensive monitoring and aggressive fluid resuscitation
What needs to be monitored annually in someone with chronic pancreatitis?
HbA1c
