Pancreatitis Flashcards
Define acute pancreatitis
An inflammation of the pancreas
Most common causes of acute pancreatitis
- Gallstones
- Alcohol
GET SMASHED
- Gallstones
- Ethanol (Alcohol)
- Trauma
- Steroids
- Mumps
- Autoimmune disease, such as (SLE) or Sjogren’s syndrome
- Scorpion venom (a rare and unlikely cause in most countries)
- Hypercalcaemia
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Drugs, such as Azathioprine, NSAIDs, or Diuretics
Acute pancreatitis pathophysiology
- Premature activation of trypsinogen into trypsin → autodigestion of the pancreas
- inflammation and fat necrosis local/system damage
- SIRS → Multi-organ dysfunction (lungs, kidneys, liver), Hypocalcemia, shock
Acute pancreatitis Sx
- Sudden onset severe epigastric pain radiating to the back
- Nausea
- Vomiting
Acute pancreatitis clinical signs
- Low grade fever
- Tachycardic
- Peritonism, rebound tenderness and guarding may be seen
- Hypotension (if in shock)
diagnostic level of amylase for acute pancreatitis
3x the upper limit of normal
Acute pancreatitis AXR findings
sentinel loop sign
retroperitoneal haemorrhage signs in acute pancreatitis
- Cullen’s sign - bruising arounf the umbilicus
- Grey’s-Turner’s sign - bruising in the flanks
SAD PUCKER
Retroperitoneal organs
- Suprarenal (adrenal) glands
- Aorta / IVC
- Duodenum
- Pancreas
- Ureters
- Colon (ascending/descending)
- Kidneys
- Esophagus
- Rectum
Gold standard diagnostic Ix for acute pancreatitis
serum lipase
Which serum enz is more accurate in diagnosing late presentation of acute pancreatitis
Lipase - stay elevated for 7-14D
What serum enz. is indicated for early presentation of actue pancreatitis
Amylase - peak in the first 12 hours of Sx onset
Acute pancreatitis fluid Mx
- IV crystalloid 4-6 hourly and review
- Catheterisation - urine output (>0.5ml/kg/hr) for fluid balance chart
Acute pancreatitis local complications
- Pancreatic pseudocyst
- Pancreatic necrosis
Define Pancreatic Pseudocyst
a collection of fluid containing pancreatic enzymes, blood, and necrotic tissue post acute pancreatitis - third space shifting
Pancreatic Pseudocyst Mx
surgical debridement or endoscopic drainage
ERCP indications in acute pancreatitis
Endoscopic Retrograde Cholangiopancreatography
- Gallstone-Induced (Biliary) Acute Pancreatitis with Obstruction
- Cholangitis - acute pancreatitis is complicated by cholangitis
- Pancreatic Duct Injury or Stricture (e.g., pancreatic ascites or pseudocyst formation)
Pancreatic necrosis definitive Mx
Necrosectomy
