Pancreatitis Flashcards
What is pancreatitis
Inflammation of the pancreas which can be acute or chronic
Causes of pancreatitis
Gallstones, alcohol, post-ERCP
Symptoms of acute pancreatitis
Rapid onset of inflammation and symptoms
Symptoms of chronic pancreatitis
Longer-term inflammation and symptoms with a progressive and permanent deterioration
How do gallstones cause pancreatitis
Gallstones getting trapped at the end of the biliary system blocking the flow of bile and pancreatic juice into the duodenum
Who is gallstone pancreatitis more common in
Women and older patients
How does alcohol cause pancreatitis
It is directly toxic to pancreatic cells resulting in inflammation
I GET SMASHED mnemonic for remembering causes of pancreatitis
Idiopathic, gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion sting, hyperlipidaemia, ERCP, drugs
Which drugs can cause pancreatitis
Furosemide, thiazide diuretics and azathioprine
Presentation of acute pancreatitis
Severe epigastric pain, radiating to the back, abdominal tenderness, systemically unwell, associated vomiting
How is acute pancreatitis diagnosed
Clinical diagnosis based on presenting features and amylase level
Investigations needed for the Glasgow Score
FBC, U&E, LFT, calcium, ABG
What does the Glasgow score do
Assess the severity of pancreatitis
What is the level of amylase in acute compared to chronic pancreatits
Raised more than 3x the upper limit in acute, but it chronic it may not rise because pancreas has reduced function
What is the importance of the lipase levels
Raised in acute pancreatitis, considered more sensitive and specific than amylase
Criteria for Glasgow score (PANCREAS)
PaO <8 kPA
Age >55
Neutrophils >15
Calcium <2
Urea >16
Enzymes (LDH >600 / AST/ALT >200)
Albumin <32
Sugar >10
Management of acute pancreatitis
IV fluids, nil by mouth, analgesia, treatment of cause, compications and Abx if infection
Complications of acute pancreatitis
Necrosis, infection, abscess, acute peripancreatic fluid collections, pseudocysts, chronic pancreatitis
Presentation of chronic pancreatitis
Similar symptoms to acute pancreatitis but less intense and longer lasting
Complications of chronic pancreatitis
Chronic epigastric pain, loss of exocrine function, loss of endocrine function, damage and strictures to the duct system, formation of pseudocysts or abscesses
What can loss of endocrine function cause
Diabetes
What can loss of exocrine function cause
LAck of pancreatic enzymes such as lipase
Management of chronic pancreatitis
No alcohol or smoking, analgesia, replacement of pancreatic enzymes (Creon), SC insulin, ERCP with stening, surgery
When is surgery indicated in pancreatitis
Severe chronic pain, obstruction to biliary system and pancreatic duct, pseudocysts, abscesses
Drug causes of pancreatitis (FAT SHEEP)
Ferusemide, azithioprine/asparaginase, thiazides/tetracyclines, statins/sulfonamides/sodium valproate, hydrochlorothiazide, ethanol, eostrogens, protease inhibitors and NRTIs
