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General Surgery - Phase II > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What is the presentation of Acute pancreatitis?

A

Severe epigastric pain radiating to the back
Relieved by sitting forward
Vomiting

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2
Q

What is the pathophysiology of Acute pancreatitis?

A

Pancreatic enzymes released and activated - cycles
Oedema/fluid shift/vomiting → hypovolaemic shock Enzymes → autodigestion and fat necrosis. Retroperitoneal haemorrhage may occur if vessels are autodigested
Pancreatic necrosis occurs due to inflammation

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3
Q

What are the causes of Acute pancreatitis?

A 
G - Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion bite
H - Hyperlipidaemia, Hypercalcaemia, Hypothermia
E - ERCP
D - Drugs eg Azathioprine, Thiazides
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4
Q

What are some of the signs of Acute pancreatitis?

A 
Increased HR
Increased RR
Hypovolaemia
Epigastric tenderness
Jaundice
Ileus - absent bowel sounds
Grey turners sign (Flank bruising)
Cullens sign ( Periumbilical bruising)
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5
Q

What are the differentials for Acute pancreatitis?

A

Perforated DU
MI
Mesenteric infarction
Aortic dissection

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6
Q

What is the Glasgow criteria?

A

Used to asses the severity of Acute pancreatitis and predict mortality. Uses the acronym pancreas

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7
Q

What does the acronym PANCREAS stand for? (Glasgow criteria)

A 
P - pO2  15 x 10(9)/L
C - Calcium -  16 mM
E - Enzymes - LDH > 600, AST > 200
A - Albumin -  10 mM
S - Sugar - Hyperglycaemia
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8
Q

What is seen on blood investigations in patients with Acute pancreatitis?

A 
Increased WCC
Increased Amylase & Lipase
U&Es - Dehydration, renal failure
Hypocalcaemia
High glucose
Increased CRP
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9
Q

What investigations can be done if you suspect Acute pancreatitis?

A

CXR - exclude DU

USS - would see gall stones and dilated bile ducts, inflammation

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10
Q

How do you treat Acute pancreatitis?

A 
Fluids
NBM
NGT if vomiting
Daily bloods
Hourly observations
Analgesia
*If dilated due to gallstones - ERCP*
*If pseudocyst, abscess, infected pancreatic necrosis - surgery*
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11
Q

What are some of the complications of Acute pancreatitis? (

A 
Acute respiratory distress syndrome
Hypovolaemic shock
Renal failure
Metabolic acidosis
High glucose
Low calcium
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12
Q

What are some of the later complications of Acute pancreatitis? (> 1 week)

A 
Necrosis
Infection
Abscess
Pseudocyst
Pancreato-cutaneous fistula formation
Bleeding, thrombosis
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13
Q

What is a pancreatic pseudocyst?

A

A collection of fluid in the lesser sac surrounded by granulation tissue

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14
Q

How long after the acute attack does a pseudocyst form?

A

4-6 weeks

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15
Q

How does a pseudocyst present?

A

Persisting epigastric pain

Epigastric mass

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16
Q

What are the complications of a pseudocyst?

A

Infection
Abscess
Obstruction of duodenum or CBD

17
Q

What would blood tests show in a patient with a pseudocyst?

A

Persistently high amylase, can be with high LFTs

18
Q

What are the causes of Chronic pancreatitis?

A 
A - Alcohol
G - Genetic - CF,Haemochromotosis
I - Immune
T - TAG increase
S - Structural - obstruction by tumour
19
Q

How does Chronic pancreatitis present?

A 
Epigastric pain, goes through to back
Relieved by sitting forward or a hot water bottle, exacerbated by fatty foods/alcohol
Diarrhoea
Weight loss
Diabetes - Polyuria, polydipsia
Steatorrhoea
Epigastric mass
20
Q

What investigations would you do in a patient with suspected Chronic pancreatitis?

A

Glucose - Raised
Faecal elastase - Decreased
USS - May have pseudocyst
X-Ray/CT - May have speckled calcifications

21
Q

How do you manage Chronic pancreatitis?

A

No alcohol
Reduce fatty foods
Analgesia
Pancreatin (Creon) to replace pancreatic enzymes
Manage Diabetes
Surgery eg Whipples (Distal pancreas removed) if cannot control pain, wt loss or duct blockage

22
Q

What are the complications of Chronic pancreatitis?

A

Pseudocyst
Diabetes
Pancreatic cancer
Pancreatic swelling causing biliary obstruction
Splenic vein thrombosis causing splenomegaly

23
Q

What dermatological presentation can occur with chronic pain?

A

Erythema Ab Igne

General Surgery - Phase II (9 decks)

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