Pancreatitis Flashcards
Pancreatitis?
Clinical syndrome resulting from the inflammation and destructive autodigestion of the pancreas and peripancreatic tissues
- Premature activation of zymogen granule releasing trypsin, chymotrypsin, proelastase and phospholipase A which digest the pancreas and surrounding tissue
Classification of pancreatitis?
Why?
- acute
- Chronic
Pancreatitis commonly causes?
- upper abdominal pain
- nausea
- vomiting
- fever
What separates pancreatitis from other entities?
elevations of serum amylase and lipase
Autodigestion of the pancreas is prevented by?
The packaging of pancreatic enzyme in precursor form.
The synthesis of protease inhibitor, e.g. pancreatic secretory trypsin inhibitor (PSTI) which can inactivate 20% of trypsin activity.
Also mesotrypsin, chymotrypsin and enzyme ‘y’ can inactivate trypsin. These protease inhibitors are found in acinar cell, pancreatic secretion and α1 and α2 globulin fraction of plasma.
In addition to that low calcium concentration in the acinar cell causes destruction of spontaneously activated trypsin.
Loss of any of these protective mechanism leads to zymogen activation, autodigestion of pancreas and acute pancreatitis
Pancreatitis severity and prognosis?
Severity varies and prognosis ranges from mild and self limited illness lasting 1 – 2 days to death from pancreatic necrosis , hemorrhage and sepsis
Acute pancreatitis often recurs
Repeated attacks results in permanently damaged pancreas(chronic pancreatitis)
Aetiology of pancreatitis?
I GET SMASHED: Idiopathic, Gall stones, Ethanol, Trauma, Steroids, Mumps/Malignancy, Autoimmune, Scorpion sting, Hyperlipidaemia/Hypercalcaemia, ERCP, Drugs-thiazides, valproate, azathioprine
- Alcohol and billiary disease are the most common causes
Infectious causes of pancreatitis?
Viral – mumps, rubella, coxsackie, echovirus, viral hepatitis A,B, adenovirus, CMV, EBV, HIV, Varicella
Bacterial – mycoplasma, salmonella typhi, group A strep, staphylococcus, TB, actinomycosis, Legionella
Parasitic – ascaris lumbroicodes, hydatid cyst
Metabolic causes of pancreatitis?
Hyperlipidemia
Hypercalcaemia
Uraemia
Postrenal transplant
Pregnancy, eclampsia
Hemochromatosis, hemosiderosis
Malnutrition
Diabetic ketoacidosis
Hereditary causes of pancreatitis?
Familial pancreatitis
Cystic fibrosis
Poisons and toxins causing pancreatitis?
Venom: scorpion
Inorganic : zinc, cobalt, mercuric chloride, sacchrated iron oxide
Vascular causes of pancretitis?
Vasculitis
Shock
Atheromatous embolism
Drugs that cause pancreatitis?
Immunosuppressives
Diuretics
steroids
Mechanical causes of pancreatitis?
Carcinoma of pancreas
Pancreatic divisum
Ampulla of vater stenosis
Penetrating duodenal ulcer
Clinical features of pancreatitis?
Gradual or sudden severe epigastric pain radiating to the back and relieved by sitting forward, vomiting
Cullen sign—Faint blue discoloration around umbilicus as a result of hemoperitoneum.
Grey Turner’s sign—Red-blue-purple or greenishbrown discoloration of the flank reflect tissue catabolism of hemoglobin
Pancreatic pseudocyst may be palpable in the upper abdomen (4–6 weeks later)