Pancreatitis Flashcards
Symptoms of acute pancreatitis.
- sudden onset, progressive to severe pain
- epigastric, LUQ pain
- radiate to the back
- maybe relieved by sitting up and lean forward
- exacerbated by movement
- N/V
- pale and sweaty
- tachycardia
- hypovolaemic signs: low JVP, low BP
Signs on examinations of acute pancreatitis
- RUQ & epigastrium tenderness, guarding
- tachycardia
- fever
- hypovolaemic shock
- paralytic ileus may develop; bowel sound decreases in this case
- Cullen’s sign , Grey-Turner’s sign (from retroperitoneal haemorrhage & blood vessel autodigestion)
- jaundice (if cause if gallstone or inflammed pancreas pressing on biliary tree)
Causes of acute pancreatitis
I - idiopathic
G - gallstone
E - ethanol
T - trauma
S - steroids
M - Mump or coxsackie virus
A - autoimmune
S - scorpion
H - hyperlipidaemia, hypercalcaemia
E - ERCP
D - Drug
Investigation for acute pancreatitis
CRP - >150mg/L at 36 hr post admission = severe pancreatitis
LFT - biliary tree block
serum Lipase - more than 2 fold upper limit of normal
ABG - monitor oxygenation and acid-base status
AXR - no psoas shadow = retroperitoneal fluid
- sentinel loop of prox. jejunum and ileum from ileus
(air-filled dilatation)
erect CXR - exclude other cause; perforation, air under diaphragm
CT - assess severity & complications
Management of acute pancreatitis
- Fasting
- Analgesia
- IV normal saline until vital signs are good and urine flow stays > 30 mL/h.
- Monitoring: hourly - pulse, BP, urine output
daily - FBC, U&E, glucose, amylase, ABG - ERCP and gallstone removal once stable.
- repeat CT to monitor progression
Differential Dx of acute pancreatitis
- AMI
2. any acute abdomen; PUD, acute cholecystitis, perforated oesophagus
Complications of acute pancreatitis
Early
1. Shock (ARDs), renal failure - give lots of fluid!
- sepsis
- raised glucose level (transient) - need insulin
Late
- Bleeding - eroded major vessel, need embolization
- thrombosis -in SMA, splenic art, gastroduodeanal art. causing bowel necrosis
- pancreatic necrosis
- abscess - need drainage
How to predict severity of pancreatitis
Modified Glasgow criteria - 3 or more positive within 48h or onset suggest severe pancreatitis, admit to ICU
valid for gallstone and alcohol induced pancreatitis
P - paO2 55 N - neutrophilia WCC > 15 x10^9 C - Ca 16mmol/L E - enzyme; LDH >600, AST > 200 A - albumin 10 mmol/L