Pancreatitis Flashcards
What is pancreatitis?
Inflammation of pancreas
What are the causes of Pancreatitis? (10 things)
- G – Gallstones
- E – Ethanol (alcohol)
- T – Trauma
- S - Steroids
- M – Mumps
- A – AI
- S – Scorpion bite
- H – Hyperlipidaemia
- E – ERCP
- D – Drugs (furosemide, thiazide diuretics, azathioprine)
What are the CF of Acute Pancreatitis? (4 things)
- Epigastric pain (radiates to back)
- Vomiting
- Abd tenderness
- Systemically unwell (e.g low grade fever + tachycardia)
How is a Acute Pancreatitis diagnosis made? (2 things)
- Clinically
2. Amylase level (at least 3x upper limit of normal)
What investigations should be done for sus Acute Pancreatitis? (5 things)
- FBC (for WBC)
- U&E (for urea)
- LFT (for transaminases + albumin)
- Calcium
- ABG (for PaO2 + blood glucose)
What other investigations should be done for sus Acute Pancreatitis? (4 things)
- Amylase
- CRP
- US
- CT abdomen
What will amylase be in Acute / Chronic Pancreatitis?
Acute = 3x upper limit of normal Chronic = Maybe not raised bc reduced pancreas function
What is CRP used for in Acute Pancreatitis?
Monitor level of inflamm.
What is US used for in Acute Pancreatitis?
Assessing gallstones
What is a CT abdomen used for in Acute Pancreatitis?
Assessing complications
What score is used to assess the severity of Pancreatitis?
Glasgow Score
What are the criteria of the Glasgow Score? (8 things)
- P – PaO2 = less than 8
- A – Age = 55+
- N – Neutrophils = WBC 15+
- C – Calcium = less than 2
- R – uRea = 16+
- E – Enzymes = LDH 600+ or AST/ALT 200+
- A – Albumin = less than 32
- S = Sugar = Glucose 10+
1 point for each answer
What do the Glasgow Score points correlate to in terms of severity?
0-1 = mild pancreatitis 2 = moderate pancreatitis 3+ = severe pancreatitis
What should moderate / severe cases of Acute Pancreatitis be considered for?
HDU / ICU
What is the management for Acute Pancreatitis? (7 things)
- Resus (ABCDE)
- IV fluids
- NBM
- Analgesia
- ERCP / Cholecystectomy (if any gallstones)
- Abx (if specific infection evidence e.g abscess / infected necrotic area)
- Treat complications (e.g endoscopic / percutaneous drainage or collections)
How long does it take most Acute Pancreatitis patients to get better once treatment is started?
3-7 days
What are the complications of Acute Pancreatitis? (6 things)
- Pancreas necrosis
- Infection of necrotic area
- Absces
- Acute peripancreatic fluid collections
- Pseudocysts (pancreatic juice collection) (dev 4 weeks after AP)
- Chronic pancreatitis
What are the complications of Acute Pancreatitis that can be seen on a CT abdomen? (3 things)
- Necrosis
- Abscesses
- Fluid collection
What are the management options for Chronic Pancreatitis? (6 things)
- X Alcohol n smoking
- Analgesia
- Replacement pancreatic enzymes (Creon) (if der is loss)
- Subcut insulin regimes (for any diabetes)
- ERCP w stenting (for strictures / obstruction to biliary system + pancreatic duct)
- Surgery
What is surgery used to treat in Chronic Pancreatitis? (4 things)
- Severe chronic pain (drain ducts + remove inflamed pancreatic tissue)
- Obstruction of biliary system + pancreatic duct
- Pseudocysts
- Abscesses
What can a lack of pancreatic enzymes lead to?
Malabsorption of fat
What can malabsorption of fat caused by lack of pancreatic enzymes lead to? (2 things)
- Steatorrhea
2. Vit ADEK (fat soluble) deficiency
What are the complications of Chronic Pancreatitis? (6 things)
- Chronic epigastric pain
- Loss of exocrine function –> lack of pancreatic enzymes sec into GIT (esp lipase)
- Loss of endocrine function –> lack of insulin –> diabetes
- Damage + strictures to duct system –> obstruction in excretion of pancreatic juice + bile
- Pseudocysts
- Abscesses
What is the thing that shows you the progression of Chronic Pancreatitis?
Faecal elastase
