Pancreatitis Flashcards

1
Q

What is the difference between acute and chronic pancreatitis

A

Acute
Rapid onset, normal function usually returns

Chronic
Long-term inflammation and symptoms
Progressive and permanent deterioration in function

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2
Q

What are the 3 key causes of pancreatitis?

A

Gallstones
Alcohol
Post-ERCP

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3
Q

What is the pathophysiology of gallstone pancreatitis?

A

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

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4
Q

How does alcohol cause acute pancreatitis?

A

Alcohol directly toxic to pancreatic cells

Causes inflammation

Men
Younger patients

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5
Q

How do you remember the majority of causes of pancreatitis?

A

Idiopathic

Gallstones
Ethanol
Trauma

Scorpion sting
Mumps
Autoimmune
Steroids
Hyperlipidaemia
ERCP
Drugs (furosemide, thiazide diuretics and azathioprine)

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6
Q

How does acute pancreatitis present?

A

Severe epigastric pain

Radiating through to the back

Vomiting

Abdominal tenderness

Systemically unwell

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7
Q

What scoring system is used to assess the severity of pancreatitis?

A

Glasgow score

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8
Q

What is required for calculating a Glasgow score?

A

FBC (white cell count)
U&Es (urea)
LFT
Calcium
ABG

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9
Q

What is raised in acute pancreatitis?

A

Amylase, more than 3 times upper limit
(chronic may not rise due to decreased function)

Lipase (more sensitive and specific than amylase)

CRP

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10
Q

What imaging is used for pancreatitis?

A

Ultrasound
CT abdomen (for complications of pancreatitis)

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11
Q

What do different Glasgow scores mean?

A

0 or 1- mild pancreatitis

2- moderate pancreatitis

3 or more - severe pancreatitis

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12
Q

What mnemonic is used for Glasgow score?

A

Pao2 < 8KPa

Age > 55

Neutrophils (WBC > 15)

Calcium < 2

uRea > 16

Enzymes ( LDH > 600 or AST/ALT > 200)

Albumin < 32

Sugar (glucose > 10)

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13
Q

How is acute pancreatitis managed?

A

ICU

IV fluids
NbM
Analgesia
ERCP for gallstones
Antibiotics
Complication treatment

Improvement in 3-7 days

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14
Q

What are the complications of acute pancreatitis?

A
  • 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
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15
Q

What does chronic pancreatitis result in?

A

Fibrosis and reduced pancreatic function

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16
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol

17
Q

What are the key complications of chronic pancreatitis?

A

Chronic epigastric pain

Loss of exocrine function
- Lack of pancreatic enzymes secreted into GI tract

Loss of endocrine function
- Lack of insulin, leading to diabetes

Damage and strictures to duct system
- Obstruction in excretion of pancreatic juice and bile

Pseudocyst or abscess formation

18
Q

How is chronic pancreatitis managed?

A

No alcohol or smoking

Analgesia

Replacement pancreatic enzymes (Creon) e.g. lipase (can lead to steatorrhea) and deficiency in fat soluble vitamins (ADEK)

Subcutaneous insulin

ERCP with stenting (for obstructions)

Surgery