Pancreatitis Flashcards
Describe the protective mechanisms of the pancreas to ensure than auto-digestion does not occur?
- Proteases released as inactive zymogens and are only activated once in the duodenum
- Also, stored with the enzymes are protease inhibitors to prevent trypsin activation
What is the definition of acute pancreatitis?
Rapid onset of inflammation of the pancreas
What is the definition of chronic pancreatitis?
Long-standing inflammation of the pancreas
What are the causes of acute pancreatitis?
Gall stones Ethanol - Alcohol Trauma Steroid Mumps and other viruses Auto-immune conditions Scorpion/snake bite Hypothermia/hypercalcaemia, typertriglyceridemia ERCP Drugs
What are the drugs which can cause acute pancreatitis?
Steroids and sulphonamides
Azothioprine
NSAIDs
D - Diuretics
What is azothioprine?
An immunosuppressant
Which autoimmune conditions can cause acute pancreatitis?
Polyarteritis nodosa, SLE
Which viruses can cause AP?
Mumps, EBV - Epstein-Barr Virus, CMV - Cytomegalovirus
What three factors can cause an increase in the permeability of the pancreatic duct?
Alcohol, acetylsalicylic acid, histamine
What happens to the acinar cell enzymes when the permeability of pancreatic duct epithelium is increased?
Acinar cell enzymes diffuse into periductal interstitial tissue
What are the two most common causes of acute pancreatitis
Alcohol and Gall Stones
What three things can happen as a result of gall stones in the ampulla which result in acute pancreatitis?
- Stuck in ampulla = blocks pancreatic juice secretion which increases pressure on acini
- Stuck in ampulla = reflux of bile into the pancreas
- Gall stone that was previously stuck become loosened, howeer sphincter of Oddi loses its competence which means that some activated duodenal enzymes might reflux into the pancreatic duct
How does alcohol contribute to acute pancreatitis?
- Causes the precipitate of proteins in the pancreatic duct which increase the pressure inside the duct
- Alcohol also increases the permeability of the pancreatic duct epithelium
The increased back pressure encourages pancreatic enzyme to leak out the duct further
What affect does trypsin activation have on the islet cells of the pancreas?
Causes islet necrosis which decrease insulin secretion and therefore increases glucose = hyperglycaemia
How does trypsin activation cause bleeding?
Activates elastase which degrade blood vessel walls, leading to bleeding
How does trypsin activation cause ischaemia?
Activates thrombin which leads to ischaemia in some parts of the vessel
What is meant by oedematous pancreatitis?
Swelling of the pancreas
What is meant by haemorrhagic pancreatitis?
The pancreas is bleeding
What is meant by necrotic pancreatitis?
The pancreatic tissue is dying - can be identifies on a scan with a porridge consistency of a pancreas
What are the three main symptoms of AP?
Epigastric pain
N and V - Alot of V
Fever
What eases the epigastric pain that patients with acute pancreatitis experience?
Sitting forward
What type of pain do patients with AP experience?
Epigastric pain radiating to back
Why do patients with AP experience fevers?
Due to infection
What is Grey-Turner’s sign?
Bruising in flanks