Pancreatitis Flashcards
What is pancreatitis?
inflammation of the pancreas
What is acute pancreatitis?
A disorder of the exocrine pancreas associated with acinar cell injury with local and systemic inflammatory response
What is chronic pancreatitis?
involves longer-term inflammation and symptoms with a progressive and permanent deterioration in pancreatic function.
3 key causes of pancreatitis?
Gallstones
Alcohol
Post-ERCP (endoscopic retrograde cholangio pancreatograph)
What is gallstone pancreatitis?
gallstones getting trapped at the end of the biliary system (ampulla of Vater)> blocks the flow of bile and pancreatic juice into the duodenum > Reflux of bile into the pancreatic duct> prevents pancreatic juice containing enzymes from being secreted, results in inflammation in the pancreas.
What is gallstone pancreatitis more common in?
Women and older patients
Alcohol and pancreatitis?
Alcohol is directly toxic to pancreatic cells, resulting in inflammation.
Alcohol-induced pancreatitis is more common in men and younger patients.
Pneumonic for causes of pancreatitis?
I GET SMASHED
I GET SMASHED
I – Idiopathic
G – Gallstones
E – Ethanol (alcohol consumption)
T – Trauma
S – Steroids
M – Mumps
A – Autoimmune
S – Scorpion sting (the one everyone remembers)
H – Hyperlipidaemia
E – ERCP
D – Drugs (furosemide, thiazide diuretics and azathioprine)
Presentation of acute pancreatitis
Severe epigastric pain
Radiating through to the back
Associated vomiting
Abdominal tenderness
Systemically unwell (e.g., low-grade fever and tachycardia)
Anorexia
Jaundice
hypotension
Dehydration
Acute pancreatitis is a clinical diagnosis, based mainly on the presenting features and the amylase level.
Initial investigations for any acute abdomen:
FBC (for white cell count)
U&E (for urea)
LFT (for transaminases and albumin)
Calcium
ABG (for PaO2 and blood glucose)
What is raised in acute pancreatitis
Amylase is raised more than 3 times the upper limit of normal in acute pancreatitis.
Lipase is also raised in acute pancreatitis. It is considered more sensitive and specific than amylase.
What is the Glasgow score
The Glasgow score is used to assess the severity of pancreatitis. It gives a numerical score based on how many of the key criteria are present:
0 or 1 – mild pancreatitis
2 – moderate pancreatitis
3 or more – severe pancreatitis
How can the criteria for the Glasgow score be remembered?
PANCREAS Pnemonic
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)
Management of acute pancreatitis
Require admission to supportive management - moderate or severe cases should be considered for high dependency unit or ICU
Management involves:
-Initial resuscitation (ABCDE approach)
-IV fluids
-Nil by mouth
-Analgesia
-Careful monitoring
-Treatment of gallstones in gallstone pancreatitis (ERCP / cholecystectomy)
-Antibiotics if there is evidence of a specific infection (e.g., abscess or infected necrotic area)
-Treatment of complications (e.g., endoscopic or percutaneous drainage of large collections)
Ho long does it take to for patients with acute pancreatitis to improve
3-7 days