pancreatitis Flashcards
what is the classical acute pancreatitis
They get sudden onset severe abdominal pain and patients may be seriously shocked
Elevated serum amylase
pain may go to the back
indigestion
temperature a
jaundice
Pathogenesis of acute pancreatitis
- Bile reflux, duct ____ due to ___ damage to the sphincter of Oddi all cause pancreatic duct ______ injury
- The loss of _____ barrier allows the _______ of pancreatic acini - Release of lytic pancreatic enzymes - ____ and ____
- Bile reflux, duct obstruction due to stone damage to the sphincter of Oddi all cause pancreatic duct epithelial injury
- The loss of protective barrier allows the autodigestion of pancreatic acini - Release of lytic pancreatic enzymes - proteases and lipases
______- cause tissue destruction and haemorrhage
Proteases - cause tissue destruction and haemorrhage
_____ - intra-and peripancreatic fat necrosis.
This atttracts _____
Lipases - intra-and peripancreatic fat necrosis
This attracts calcium
______ is an almost immediate consequence of acute of Release of lytic pancreatic enzymes - proteases and lipases
haemorhage
what are the systemic complications of acute?
pulmonary failure renal failure (HIGHLY LIKELY) sepsis metabolic acidosis Death Shock Hypocalcaemia Hyperglycaemia
what is chronic pancreatitis
Relapsing disorder may develop insidiously or following bouts of acute pancreatitis
what are the causes of chronic pancreatitis?
Alcohol Cholelithiasis Cystic fibrosis Hyperparathyroidism Familial viral infection hypothermia trauma drugs
what is the pathology of chronic?
Get the replacement of pancreas by chronic inflammation and scar tissue
Destruction of exocrine acini and islets (islets tend to last longer)
in chronic The inflammation and firbosis mimicks a ____ in the head of the pancreas
tumour
in acute P what is the management If they are a surgical candidate:
Cholecystectomy
in acute P what is the management If they are a non surgical candidate:
- ERCP/ES if frail
They will have a sphincterotomy too to prevent blockage of stones as this will allow them to pass straight through to the duodenum
minimal organ dysfunction and uneventful recovery. Predominant feature is interstitial oedema of the gland
mild acute pancreatitis
what is the pancreatitis associated with organ failure and /or local complication such as necrosis, pseudocysts or abscess
severe acute pancreatitis
mumps, coxsackie B and viral hepatitis
what viruses can cause acute pancreatitis
how is a diagnosis of ACUTE pancreatitis made?
history ,
examination (tenderness, peritonism, distension, bowel sounds and skin markings)
and blood tests
what blood tests are usually done?
FBC, Clotting, U & E’s, LFT’s, Amylase, CRP, Glucose, Ca
what is the FBC like in acute pancreatitis ?
leukocytosis
what do the lipase and amylase show in acute pancreatitis?
both raised but amylase raised by 3x ULN
what does haematocrit tell you
it is a predictor of pancreatic necrosis
what is ABG like for acute pancreatitis
hypoxaemia and disturbances in acid base balance
what imaging may be done in acute pancreatitis
CXR/AXR, AUS, CT Pancreas, MRI, ERCP- these are not diagnostic but can be useful
what is the first imaging tool you ask for and why? for acute pancreatitis
US to rule out biliary pancreatitis
what may be seen on CXR/AXR of acute pancreatitis?
sentinel loop or pleural effusion
what is a sentinel loop
localised ileus from nearby inflammation
what are the local complications of acute pancreatitis
fluid collections pancreatic necrosis ascites bleeding abscess pseudocyst formation
what are pseudocysts
collections of fluid with high enzyme concentrations
complication of AP and CP which can cause biliary obstruction and gastric outlet obstruction
the patient has pain, nausea, vomiting, jaundice, weight loss
pseudocyst
what is the treatment for a pseudocyst
endoscopic drainage or surgical drainage
This is basically an infected cyst
pancreatic abscess
what is the treatment of pancreatic abscess
Drain abscess, control sepsis
Via CT/US guided retroperitoneal or transperitoneal drainage
what is CT used for in pancreatitis
to assess severity of necrosis
this is a progressive and irreversible destruction of the pancreatic tissue which results in the loss of endocrine and exocrine function
chronic pancreatitis
what are the causes of CP?
alcohol - 60-80% pancreatic duct obstruction autoimmune tropical pancreatitis hereditary hypercalcaemia in hyperparathyroidism
what is the rare but important hereditary cause of CP
CF
what are some acquired causes of pancreatic duct obstruction
cholelithiasis, stricture, tumour pseudocyst
what is a congenital cause of pancreatic duct obstruction
pancreas divisum
what are the first tests to order in CP
blood tests
CT
US
AXR
what may AXR and CT show for CP
calcifications
what may need to be supplemented in CP
insulin, lipase,fat soluble vitamins
what surgery can be done for unremitting pain or weight loss in CP
Pustow procedure for dilated pancreatic duct - pancreeatic duct is anastomosed to jejunum
what are the complications of chronic CP?
splenic vein thrombosis
- risk of pancreatic cancer
- pseudocyst
- pseudoaneurysms
- bile duct or duodenal obstruction
- pancreatic ascites
- pleural effusion
- diabetes
what is a pseudoaneurysm?
erosion of a pseudocyst into an artery
what is the treatment for biliary or duodenal obstriction
stent, bypass or resection
