Pancreatitis Flashcards
What is acute pancreatitis and why does it occur?
- refers to the inflammation of the pancreas due to abnormal release and activation of pancreatic enzymes resulting in autodigestion of pancreatic tissue.
- self-limiting, reversible pancreatic injury associated with epigastric pain and pancreatic enzyme elevation
What are the causes of acute pancreatitis and what are the two main causes?
I GET SMASHED:
I- Idiopathic
G- Gallstones
E- ethanol
T- trauma
S- Streoids
M- Mumps
A- autoimmune
S- Scorpion sting
H- Hyperlipidemia, hypercalcemia
E- ERCP
D- Drugs
Most common causes are alcohol and gallstones.
Which pancreatic cells have an endocrine and exocrine function, and what hormones/substances do they produce?
Endocrine- islets of langerhans- insulin and glucagon
exocrine- pancreatic ductal cells- pancreatic juices composed of bicarbonate and digestive enzymes (trypsin- key to the development of pancreatitis)
How does a patient present with acute pancreatitis?
- abdominal, epigastric pain that radiates to the back
- N&V
- fever
- tachycardia
- diarrhoea
- anorexia
What are some bruising signs specific to acute pancreatitis?
1) Cullen’s sign- peri-umbilical bruising
2) Grey-Turner’s sign- flank bruising
Note: these signs represent internal bleeding and can be seen as relatively late sign in severe heamorrhagic pancreatitis.
What investigations would you do for acute pancreatitis?
- amylase and lipase (serum levels of the two elevated 3 times above the reference range is considered diagnostic for pancreatitis)
- FBC- CRP
- U&Es
- LFTs (to assess for any evidence of cholangitis)
- Bone profile- hypocalcemia is common (scoring)
- LDH (used in scoring)
- Serum glucose (scoring)
- lipids (hyperlipidemia is a cause of pancreatitis)
- arterial blood gas (pO2 used for scoring)
Imaging:
- US- to see gallstones or dilated CBD
- CT- to confirm diagnosis
- MRCP- most commonly used in suspected gallstone-related pancreatitis
Scoring system:
- the glasgow score is used to assess the severity of acute pancreatitis.
- A score of 3 or greater indicates severe pancreatitis, these patients have high mortality
How do you manage acute pancreatitis?
Analgesia, fluids, nutritional support
How would you manage gallstone pancreatitis?
- supportive management (fluids, analgesia, nutritional support)
- biliary decompression
- cholecystectomy- following recovery from gallstone pancreatitis.
- antibiotics in patients with suspected cholangitis or other infective source
- ERCP- In patients with gallstone pancreatitis, CBD stones and cholangitis urgent decompression is required. ERCP should also be promptly organised for those with stones obstructing the CBD. This can be achieved with ERCP and stone extraction
What are the local complications of acute pancreatitis? How do you treat/manage them?
1) Pancreatic necrosis- In certain cases, continued inflammation leads to localised thrombosis, haemorrhage and necrosis within the pancreas. Though initially sterile, there is a 30-70% chance of infection. This is a major cause of mortality in those with acute pancreatitis. CT guided fine needle aspiration and culture. Culture positive patients are generally managed with appropriate antibiotics.
2) pancreatic pseudocyst formation- organized peripancreatic collections of pancreatic fluid, nromally defined as being present for four weeks or more after an acute episode.
3) Vascular complications:
a) pseudoaneurysm- it can affect any local vessel ut it is often seen in splenic and hepatic arteries. life-threatening hemorrhages can result from this.
b) Venous thrombosis- may affect the portal, splenic and superior mesenteric veins.
What are some systemic complications can can arise from severe acute pancreatitis?
- Acute respiratory distress syndrome (ARDs)
- Renal Failure
- Shock
What is the prognosis of acute pancreatitis like?
The overall mortality of pancreatitis is estimated at 3-5%. However, severe acute pancreatitis may be associated with a mortality of 20-40%.
What is chronic pancreatitis?
Chronic pancreatitis is traditionally considered as chronic, irreversible, inflammation and/or fibrosis of the pancreas.
What is the leading cause of chronic pancreatitis? And what effects does the condition have?
- Alcohol is the leading cause
- injury leads to structural and/or functional changes that include atrophy, calcification, strictures, exocrine and endocrine dysfunction, and an increase in the risk of pancreatic cancer.
What exocrine and endocrine effects does chronic pancreatitis have?
1) Endocrine dysfunction: damage to the islet cells result in lack of insulin and development of diabetes mellitus
2) Exocrine dysfunction: damage to the acinar cells results in lack of pancreatic enzymes and malabsorption
