Pancreatitis Flashcards
What is the presentation of Acute pancreatitis?
Severe epigastric pain radiating to the back
Relieved by sitting forward
Vomiting
What is the pathophysiology of Acute pancreatitis?
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
What are the causes of Acute pancreatitis?
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
What are some of the signs of Acute pancreatitis?
Increased HR Increased RR Hypovolaemia Epigastric tenderness Jaundice Ileus - absent bowel sounds Grey turners sign (Flank bruising) Cullens sign ( Periumbilical bruising)
What are the differentials for Acute pancreatitis?
Perforated DU
MI
Mesenteric infarction
Aortic dissection
What is the Glasgow criteria?
Used to asses the severity of Acute pancreatitis and predict mortality. Uses the acronym pancreas
What does the acronym PANCREAS stand for? (Glasgow criteria)
P - pO2 15 x 10(9)/L C - Calcium - 16 mM E - Enzymes - LDH > 600, AST > 200 A - Albumin - 10 mM S - Sugar - Hyperglycaemia
What is seen on blood investigations in patients with Acute pancreatitis?
Increased WCC Increased Amylase & Lipase U&Es - Dehydration, renal failure Hypocalcaemia High glucose Increased CRP
What investigations can be done if you suspect Acute pancreatitis?
CXR - exclude DU
USS - would see gall stones and dilated bile ducts, inflammation
How do you treat Acute pancreatitis?
Fluids NBM NGT if vomiting Daily bloods Hourly observations Analgesia *If dilated due to gallstones - ERCP* *If pseudocyst, abscess, infected pancreatic necrosis - surgery*
What are some of the complications of Acute pancreatitis? (
Acute respiratory distress syndrome Hypovolaemic shock Renal failure Metabolic acidosis High glucose Low calcium
What are some of the later complications of Acute pancreatitis? (> 1 week)
Necrosis Infection Abscess Pseudocyst Pancreato-cutaneous fistula formation Bleeding, thrombosis
What is a pancreatic pseudocyst?
A collection of fluid in the lesser sac surrounded by granulation tissue
How long after the acute attack does a pseudocyst form?
4-6 weeks
How does a pseudocyst present?
Persisting epigastric pain
Epigastric mass
What are the complications of a pseudocyst?
Infection
Abscess
Obstruction of duodenum or CBD
What would blood tests show in a patient with a pseudocyst?
Persistently high amylase, can be with high LFTs
What are the causes of Chronic pancreatitis?
A - Alcohol G - Genetic - CF,Haemochromotosis I - Immune T - TAG increase S - Structural - obstruction by tumour
How does Chronic pancreatitis present?
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
What investigations would you do in a patient with suspected Chronic pancreatitis?
Glucose - Raised
Faecal elastase - Decreased
USS - May have pseudocyst
X-Ray/CT - May have speckled calcifications
How do you manage Chronic pancreatitis?
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
What are the complications of Chronic pancreatitis?
Pseudocyst
Diabetes
Pancreatic cancer
Pancreatic swelling causing biliary obstruction
Splenic vein thrombosis causing splenomegaly
What dermatological presentation can occur with chronic pain?
Erythema Ab Igne
