Pancreatitis Flashcards
Describe the pathophysiology of pancreatitis
autodigestion of pancreatic tissue by the pancreatic enzymes
=> leading to necrosis
Clinical features of pancreatitis
- severe epigastric pain radiating to back
- vomiting
What are the names given to Peri-umbilical discolouratino and flank discolouration which may be seen in pancreatitis?
periumbilical = Cullen’s sign
flank = Grey-Turner’s sign
What blood test is usually raised in pancreatitis?
serum amylase
- sensitivity ~75%
- specificity 90%
- usually >3 times upper limit of normal
Other causes of raised amylase?
pancreatic pseudocyst
mesenteric infarct
perforated viscus
acute cholecystitis
diabetic ketoacidosis (DKA)
When can serum lipase be used instead of serum amylase?
longer half-life
=> useful for late presentations >24 hours
A diagnosis of acute pancreatitis can be made clinically, without imaging. TRUE/FALSE?
TRUE
What is US imaging used pancreatitis
assess the aetiology
e.g. gallstones/biliary obstruction
What are the two most common causes of pancreatitis?
Gallstones
Alcohol
Name some scoring systems used to identify those in need of critical care management
Ranson score
Glasgow score
APACHE II.
What categories commonly indicate severe pancreatitis
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
List the causes of pancreatitis
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine, bendroflumethiazide, furosemide steroids, sodium valproate)
Local complications of pancreatitis
- Peripancreatic fluid collection
- Pseudocysts
- Necrosis
- Abscess
- Haemorrhage
How long after an attack of pancreatitis do pseudocysts usually occur?
4 weeks
Describe the location of most pancreatic pseudocysts
retrogastric
Describe the amylase in patient with a pancreatic pseudocyst
persistently mildly elevated
What imaging can be used to assess for pancreatic pseudocysts?
CT
ERCP
MRI
endoscopic USS
Definitive tx of pseudocysts
endoscopic or surgical cystogastrostomy or aspiration
Why do we not drain peripancreatic fluid collections?
Most will resolve
can introduce infection
What clinical sign may be present if a retroperitoineal haemorrhage has occurred after an attack of pancreatitis?
Grey-Turners sign (flank bruising)
Main causes of chronic pancreatitis
Genetic:
- cystic fibrosis
- haemochromatosis
Ductal obstruction:
- tumour
- stones
- structural abnormalities (pancreas divisum and annular pancreas)
Clinical features of chronic pancreatitis?
pain worse 15 to 30 minutes following a meal
steatorrhoea
diabetes mellitus late to develop
Imaging of chronic pancreatitis
AXR shows pancreatic calcification in 30%
CT is more sensitive
What investiagtion can be used if imaging is inconclusive for a diagnosis of chronic pancreatitis
faecal elastase
- used to assess exocrine function
Management of chronic pancreatitis
- pancreatic enzyme supplements
- analgesia
- ?antioxidants
