Pancreatitis Flashcards
What are the causes of acute pancreatitis?
Three main: Gallstones, alcohol and post-ERCP
I GET SMASHED:
Idiopathic,
Gallstones,
Ethanol,
Trauma,
Steroids,
Mumps,
Autoimmune,
Scorpion sting
Hyperlipidaemia,
ERCP
Drugs (furosemide, thiazide diuretics or azathioprine
What causes of drug induced pancreatitis?
FAT SHEEP.
- Furosemide,
- Azathioprine,
- Thiazides/tetracyclines,
- Statins/sulfonamides/sodium valproate,
- Hydrochlorothiazide,
- Oestrogens,
- Ethanol,
- Protease inhibitors
Explain the presentation of pancreatitis?
- Severe epigastric pain which radiated to the back,
- Associated with vomiting and abdominal tenderness and systemically unwell.
- Grey turner’s sign (bruising along the flanks) which suggests bleeding.
- Cullen’s sign (bruising around peri-umbilical area)
- Release of inflammatory mediators can result in ARDS, plural effusions and hypovolaemia leading to AKI
- Ileus
What are the investigations for pancreatitis?
- Amylase (more than 3x upper limit of normal)
- Lipase which is more sensitive/specific,
- CRP
- FBC,
- U&Es,
- LFTs
- Calcium
- ABG
- Ultrasound (for gallstones)
- CT for complications
What scoring system is used for acute pancreatitis?
Glasgow score.
PaO2 <8KPa
Age >55
Neutrophils >15
Calcium <2,
uRea > 16
Enzymes
Albumin
Sugar
What is the management of acute pancreatitis?
- IV fluids, aim to keep urine output >30mL/hour
- Nil by mouth,
- Analgesia,
- Monitoring,
- Treat gallstones, or give Abx or treat complications
What are the complications of acute pancreatitis?
- Necrosis,
- Infection of necrotic area,
- Abscess formation,
- Acute peripancreatic fluid collection,
- Pesudocysts,
- ARDS
- Fistula,
- AKI,
- DIC
- Chronic pancreatitis
What is the most common cause of chronic pancreatitis?
Alcohol. Other causes include:
Cystic fibrosis, haemochromatosis, ductal obstruction
What are the key complications of chronic pancreatitis?
Chronic epigastric pain,
Loss of exocrine function (causing fatty stools and malabsorption)
Loss of endocrine function (causing diabetes due to lack of insulin)
Damage and strictures to ducts
Formation of peudocyts/abscess
What is the management of chronic pancreatitis?
- Abstinence from alcohol and smoking.
- Analgesia.
- Replacement pancreatic enzymes (creon) and subcut insulin.
- ERPC if gallstones.
- Surgery for the complications
What are the investigations for chronic pancreatitis?
Abdominal X-ray or CT which shows pancreatic calcifications
Functional investigations - fasting glucose and faecal elastase.
Note - Amylase/lipase are not raised which is different from acute
What are the symptoms of chronic pancreatitis?
Pain (worse 15-30mins following a meal)
Steatorrhoea
weight loss
Diabetes mellitus
What are the local complications of acute pancreatitis?
Necrosis
Infected cysts (require drainage)
Pseudocyst
Gastric outlet obstruction
Haemorrhage
Portal vein thrombosis
What are the distant complications of acute pancreatitis?
ARDS
Shock
Arrhythmias
AKI
DIC
Ileus
Electrolyte abnormalities
Ascites
Pleural effusions
What is the diagnostic work up for gallstone pancreatitis
USS > MRCP > ERCP +/- sphincterotomy > cholecystectomy
