Pancreatitis Flashcards

1
Q

Pancreatitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Classification of pancreatitis?
Why?

A
  1. acute
  2. Chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pancreatitis commonly causes?

A
  1. upper abdominal pain
  2. nausea
  3. vomiting
  4. fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What separates pancreatitis from other entities?

A

elevations of serum amylase and lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Autodigestion of the pancreas is prevented by?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pancreatitis severity and prognosis?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aetiology of pancreatitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infectious causes of pancreatitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Metabolic causes of pancreatitis?

A

Hyperlipidemia
Hypercalcaemia
Uraemia
Postrenal transplant
Pregnancy, eclampsia
Hemochromatosis, hemosiderosis
Malnutrition
Diabetic ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hereditary causes of pancreatitis?

A

Familial pancreatitis
Cystic fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Poisons and toxins causing pancreatitis?

A

Venom: scorpion
Inorganic : zinc, cobalt, mercuric chloride, sacchrated iron oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vascular causes of pancretitis?

A

Vasculitis
Shock
Atheromatous embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Drugs that cause pancreatitis?

A

Immunosuppressives
Diuretics
steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mechanical causes of pancreatitis?

A

Carcinoma of pancreas
Pancreatic divisum
Ampulla of vater stenosis
Penetrating duodenal ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical features of pancreatitis?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations?

A

Serum amylase – raised > 1000u/ml. cholecystitis, mesenteric infarction, and GI perforation can cause lesser rises
Serum lipase more sensitive and specific for pancreatitis
ABG
CXR to rule out perforation
CT abdomen with contrast

17
Q

Management?

A

NPO
IV fluids to counter third space sequestration
Catheterise
Analgesia
Check vital signs
Laparotomy or debridement if worsening
Antibiotics
ERCP and gallstone removal if worsening jaundice

18
Q

Early complications?

A

Shock, ARDS, renal failure, hypocalcemia, hyperglycaemia

19
Q

Late complications?

A

Pancreatic necrosis and pseudocyst
Abscesses
Bleeding
Fistula
Recurrent oedematous pancreatitis

20
Q

Chronic pancreatitis?

A

Progressive
Irreversible destruction
Permanent loss of
endocrine function
exocrine function
often chronic severe pain

21
Q

Classification of chronic pancreatitis?

A

TIGARO
Toxic-metabolic
Idiopathic
Genetic
Autoimmune
Reccurent and severe acute pancreatitis
Obstructive

22
Q
A