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4 - Case 3 > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Acute Pancreatitis

A

Sudden onset
Life threatening
Reversible

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2
Q

Causes of AP

A 
Idiopathic (20%)
Gallstones obstructing pancreatic duct (50%)
Ethanol (25%)
Trauma
Steroids
Mumps
Autoimmune
Scorpion bites
Hyperlipideamia/hypothermia
ERCP
Drugs
I GET SMASHED
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3
Q

Risk factors for gallstones

A

Female
Fat
Fertile
Forty

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4
Q

Pathogenesis of AP

A

Release of lytic enzymes (trypsin, lipase, phospholipidase A2) that digest pancreatic tissue and cause fat necrosis
Mild- pancreatic inflam and oedema
Severe- pancreatic necrosis and multi organ failure

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5
Q

Signs and symptoms of AP

A 
Severe epigastric pain that radiates to back (as pancreas is covered by peritoneum in front but not at back)
Nausea, vomiting
resp distress
fever
haemorrhae, shock
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6
Q

Diagnosis of AP

A

Severe abdo pain
Raised serum amylase during first 24 hrs
Raised serum lipase within 73-96 hrs
Imaging; USS and CT

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7
Q

Prevent recurrence of AP

A

Remove gallstones by ERCP or cholecystectomy
reduce alcohol
consider drug causes

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8
Q

4 key pathological features of Chronic Pancreatitis

A
  • Chronic, continuous inflammation
  • Fibrous scarring
  • Impaired pancreatic function (exo and endocrine)
  • Duct strictures with formation of calculi
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9
Q

Causes of CP

A

Alcohol (60-70%)

Idiopathic (20-30%)

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10
Q

Pathogenesis of CP

A

Increased acinar protein secreted and reduction in NaHCO3 and fluids causes increased viscosity pancreatic duct (PLUGGING)
This leads to acinar atrophy and fibrosis
Alcohol may just have toxic effect on acinar cells

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11
Q

Lifestyle factors increasing CP risk

A

Tobacco smoke and alchol metabolism leads to pancreatic oxidative stress from alcohol dehydrogenase buildup.
Cytochrome P450 non-oxidative pathway and reactive oxygen species also lead to cell damage

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12
Q

Signs and symptoms of CP

A
  • Prolonged chronic Intermittent severe upper abdo pain that radiates to back
  • Pancreatic malabsorption leading to weight loss and steaorrhea
  • Diabetes by destruction of pancreatic islet cells
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13
Q

Pain causes

A

Pressure in duct or parenchyma causing pancreatic ischaemia
Inflammation and pancreatic fibrosis
Abnormal CNS pain processing
Reduced bicarbonate secretions

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14
Q

Malabsorption consequences

A

Lipase levels fall before protease and amylase. So fat malabsorbtion leads to steatorrhea (greasy stool)
Weight loss and reduced vit A, D, E, K as fat soluble
Reduces bicarbonate - acid environment
Reduced bile acid secretion

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15
Q

Dignosis of CP

A

Faecal elastase
Endoscopic ultrasound
CT/MRI

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16
Q

Management of CP

A

Lifestyle (stop smoking and alcohol)
Pain (NSAIDs, endoscopic therapy, nerve blocks, surgery)
Treat
Identify complications

17
Q

Treating CP

A

Replace pancreatic enzymes (pancreatin)
These are capsules taken before and during meals. Mimick normal secretion

Usuallt take these with a PPI

18
Q

Complications of CP

A
  • Pseudocysts; local fluid collection (usually in lesser sac) surrounded by granulation tissue. smaller than 6cm resolve on their own
  • Bleeding; variceal (due to underlying cause or splenic vein thrombosis), pseudocyst
  • Obstruction; bile duct, duodenal
  • Pancreatic cancer; common, see inc pain, weihht loss, obstructive jaundice
19
Q

Prognosis of CP

A

Age
Smoking
Liver cirrhosis
Continue alcohol

70% survival 10 yrs
45% survival 20 yrs
4% pancreatic cancer 20yrs

20
Q

Pancreatin side effects

A

nausea, vomiting, diarrhoea
skin irritation around mouth and anus
stomach pain

21
Q

What stimulates the release of enzymes in AP

A
  • hyperstimulation of pancreas from alcohol or fat
  • pancreatic duct destruction (tumours)
  • defective intracellular transport and secretion of pancreatic enzymes
  • reflux of infected bile or duodenal contents into pancreatic duct (gall stone obstruction)
22
Q

Treatment of AP

A

Keep nil by mouth
Give aggressive IV water and electrolyte replacement with opiate analgesia

IF severe need to give IV nutrition

4 - Case 3 (6 decks)

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