pancreatitis Flashcards
acute pancreatitis
rapid onset of inflammation and symptoms
chronic pancreatitis
longer-term inflammation and symptoms
progressive and permanent deterioration in pancreatic function
fibrosis
three key causes
galllstones
alcohol
post-ERCP
gallstone pancreatitis
gallstones trapped at end of biliary system (ampulla of vater) so blocking flow of bile and pancreatic juice into duodenum
reflux back into pancreas
why does alcohol cause pancreatitis
directly toxic to pancreatic cells
long list of pancreatitis causes
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hyperlipidemia Drugs: furosemide, thiazide diuretics, azathioprine
acute pancreatitis - presentation
severe epigastic pain - radiating to back assoc vomit tenderness fever tachycardia raised amylase
Ix
FBC u&es LFT calcium ABG amylase USS CT
amylase
acute - raised 3x upper limit normal
chronic - may not rise due to reduced pancreatic function
glasgow score
used to assess severity of pancreatitis ]
0-1 mild
2 moderate
3+ severe
glasgow score: P
Pa02 < 8
glasgow score: A
Age >55yrs
glasgow score: N
Neutrophils: WCC>15
glasgow score: C
Calcium <2
glasgow score: R
R urea >16
glasgow score: E
Enzymes: raised liver
glasgow score: A
Albumin <32
glasgow score: S
Sugar: glucose >10
Mx acute pancreatitis
ABCDE Iv fluifd NBM analgesia ERCP/cholecystecomy if gallstones antib if infective
acute pancreatitis: how long to recovery
most patients will improve within 3-7 days
complications of acute pancreatitis
necrosis infection abscess acute peripancreatic fluid collection pseudocysts chronic pancreatitis
chronic pancreatitis most common cause
alcohol
chronic pancreatitis presentation
similar symptoms to acute pancreatitis but less intense and longer-lasting
chronic pancreatitis complications
chronic epigastric pain loss exocrine function loss endocrine function damage and strictures pseudocyst abscess
chronic pancreatitis Mx
alcohol + smoking abstinence analgesia replacement pancreatic enzymes: creon insulin ERCP w stenting surgery
chronic pancreatitis Mx - surgery indications
severe chronic pain
obstruction
pseudocysts
abscesses
