Pancreatitis Flashcards
0
Q
What is the scoring system for severity of acute pancreatitis?
A
Modified Glasgow Criteria - PANCREAS
- P = PaO2 55
- A = Albumin 10mmol/L
- N = Neutrophilia - WCC >15
- C = Calcium 16mmol/L
- R = Renal function - Urea
- E = Enzymes - LDH, AST
- A = Age >55y/o
- S = Sugars (BM)
1
Q
What are the potential complications of pancreatitis?
A
- Pancreatic: pseudocyst, chronic pancreatitis, pancreatic necrosis.
- Systemic: SIRS & multiorgan dysfunction
- Lungs: Pleural effusion, ARDS, pneumonia
- Kidney: AKI
- GI tract: GI bleeding from gastric/duodenal ulcer, paralytic ileus
- Hepatobiliary: Jaundice, common bile duct obstruction, portal vein thrombosis
- Metabolic: Hypoglycaemia, hyperglycaemia, hypercalaemia
2
Q
What is the early management of pancreatitis?
A
- IV access and fluids
- NG suction
- Baseline ABGs
- Prophylactic Abx
- Analgesia (NOT morphine/diamorphine)
- Feeding (via NG tube)
- Anticoagulation with LMW heparin for DVT prophylaxis
- Gallstone-related pancreatitis: Endoscopic intervention with sphincterotomy and stone extraction (ERCP)
3
Q
What are the causes of acute pancreatitis?
A
I GET SMASHED (whilst pregnant)
- I = Idiopathic
- G = Gallstones
- E = Ethanol
- T = Trauma
- S = Steroids
- M = Mumps (and other viruses)
- A = Autoimmune
- S = Scorpion bite
- H = Hyperlipidaemia
- E = ERCP
- D = Drugs
- Pregnancy
4
Q
What are the clinical features of pancreatitis?
A
- Upper abdo pain
- Nausea and vomiting
- Back pain (involvement of retroperitoneum)
- More severe = tachycardia, hypotension, oliguria
5
Q
What are the specific (eponymous) signs of acute pancreatitis?
A
- Cullen’s sign: bruised umbilicus
- Grey Turner’s: flank bruising
- Rovsing’s sign: palpating of LIF produces pain in RIF
6
Q
What are the investigations in acute pancreatitis?
A
- Serum amylase
- CXR = mandatory to exclude gastroduodenal perforation (also increases amylase)
- CT = best inv - gives extent of necrosis
