PANCREATITIS Flashcards
DDx
Peptic Ulcer Disease
Gastritis
Acute Cholecystitis
*Mesenteric Ischemia
*Perforated Viscus
*SBO
*Thoracic Aortic Dissection
*Acute Coronary Syndrome
*AAA
MANAGEMENT
CLINICAL FEATURES
Epigastric Abdominal Pain (90%)
-only 50% p/w classic bandlike pain radiating to back
-10% pain free, add lipase for unexplained shock
Nausea and Vomiting (90%)
Bruising is rare:
-Cullen’s = periumbilical;
-Grey Turner’s = Flank
ETIOLOGY: MANY
Cholelithiasis (MC) (40%)
EtOH (30%)
Hyper triglycerides
Hyper Ca
Medications
Idiopathic
INVESTIGATIONS
LFT’s
LDH
Lipase
Lactate
Calcium
Triglycerides
Ultrasound :
document the presence/absence of gallstones or biliary involvement (small stones/sludge are more likely to cause pancreatitis than large stones).
CT scan with IV contrast:
‘pancreatic protocol’:
1) Pancreatic parenchymal inflammation +/- peripancreatic fat inflammation
2) Pancreatic parenchymal necrosis or peripancreatic necrosis
3) Peripancreatic fluid collection
4) Pancreatic pseudocyts
27% FN rate if done too early
CXR r/e pleural effusion for BISAP
DIAGNOSTIC CRITERIA
2/3 of Atalanta Criteria:
1) Classic midepigastric abdominal pain
2) Serum Lipase levels >/3 times the UL (99% sn, 99% sp)
3) Imaging consistent with pancreatic inflammation (IV-contrast CT or Transabdominal US)
PROGNOSIS
Ranson’s / APACHE II
COMPLICATIONS
Acute pancreatic fluid collections
Pancreatic pseudocyst
Acute pancreatic / peripancreatic necrosis
Walled off necrosis
Splenic or portal vein thrombosis
Colonic inflammation / necrosis
Organ failure: cardiovascular, respiratory, renal
