Pancreatitis Flashcards
What is the difference between acute and chronic pancreatitis
Acute
Rapid onset, normal function usually returns
Chronic
Long-term inflammation and symptoms
Progressive and permanent deterioration in function
What are the 3 key causes of pancreatitis?
Gallstones
Alcohol
Post-ERCP
What is the pathophysiology of gallstone pancreatitis?
Gallstones trapped at the end of the biliary system
Bile and pancreatic juice flow into duodenum blocked
Reflux of bile into pancreatic duct
Pancreatic juice contains enzymes
Results in inflammation in the pancreas
Women
Older patients
How does alcohol cause acute pancreatitis?
Alcohol directly toxic to pancreatic cells
Causes inflammation
Men
Younger patients
How do you remember the majority of causes of pancreatitis?
Idiopathic
Gallstones
Ethanol
Trauma
Scorpion sting
Mumps
Autoimmune
Steroids
Hyperlipidaemia
ERCP
Drugs (furosemide, thiazide diuretics and azathioprine)
How does acute pancreatitis present?
Severe epigastric pain
Radiating through to the back
Vomiting
Abdominal tenderness
Systemically unwell
What scoring system is used to assess the severity of pancreatitis?
Glasgow score
What is required for calculating a Glasgow score?
FBC (white cell count)
U&Es (urea)
LFT
Calcium
ABG
What is raised in acute pancreatitis?
Amylase, more than 3 times upper limit
(chronic may not rise due to decreased function)
Lipase (more sensitive and specific than amylase)
CRP
What imaging is used for pancreatitis?
Ultrasound
CT abdomen (for complications of pancreatitis)
What do different Glasgow scores mean?
0 or 1- mild pancreatitis
2- moderate pancreatitis
3 or more - severe pancreatitis
What mnemonic is used for Glasgow score?
Pao2 < 8KPa
Age > 55
Neutrophils (WBC > 15)
Calcium < 2
uRea > 16
Enzymes ( LDH > 600 or AST/ALT > 200)
Albumin < 32
Sugar (glucose > 10)
How is acute pancreatitis managed?
ICU
IV fluids
NbM
Analgesia
ERCP for gallstones
Antibiotics
Complication treatment
Improvement in 3-7 days
What are the complications of acute pancreatitis?
- Necrosis of the pancreas
- Infection in a necrotic area
- Abscess formation
- Acute peripancreatic fluid collections
- Pseudocysts (collections of pancreatic juice) 4 weeks after
- Chronic pancreatitis
What does chronic pancreatitis result in?
Fibrosis and reduced pancreatic function