Pancreatitis Flashcards
what are the main causes of acute pancreatitis
gall stone obstructing the ampulla avatar
alcohol - directly toxic to pancreatic cells
ERCP
what is the pathophysiology acute pancreatitis
inflammation leads to damage of the acinar cells
pancreatic enzymes are released
causes autdigestion
what are the three pancreatic enzymes
amylase - 3x the upper normal limit
protease - autodigests pancreases
lipase - can cause fatty necrosis
presentation of acute pancreatitis
severe epigastric pain
associated N+V
jaudice
fever
systemically unwell (could indicate complications present)
investigations of acute pancreatitis
FBC, Us&Es, LFTs, Ca, CRP
USS if suspected gall stone cause
CT abdomen in clinically unwell or complications suspected
what do the scores of the glasgow score
0-1: mild
2: moderate
equal or more than three: severe
for moderate or severe cases considered admission to HDU/ICU
describe the points for the Glasgow score
P - PaO2 < 8kPa
A - age >55
N - neutrophils - WBC >15
C - calcium < 2
R - urea >16
E - enzymes: LHD>600 or ATS/ALT <200
A - albumin <32
S - sugar: blood glucose >10
what is the management for pancreatitis
supportive treatment
IV fluids, analgesia, NBM, NGT
Managment of complications/gallstones
careful monitoring
when would a patient with pancreatitis require ABX
abscess or necrosis
how long does acute pancreatitis last
3-7 days
what are some complications of acute pancreatitis
necrosis - infection
abscess or collectoin
pseudocysts (4wks after)
fistula with lung - acute lung injury / pancreatic effusion
renal failure
chronic pancreatitis
GET SMASHED acronym for acute pancreatitis
G - gall stones
E - ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion sting
H - hyperlipidaemia / hypercalaemia
E - ERCP
D - drugs: furosemide, thiazides, azathioprine
what is chronic pancreatitis
persistent inflammation leading to chronic deterioration of the pancreatic function
what irreversible changes can be seen with chronic pancreatitis
fibrosis
atrophy
calcification
what are the most common causes of chronic pancreatitis
adult: alcohol
child: CF
