Pancreatitis Flashcards
Epidemiology of acute pancreatitis
3% of Acute abdomen
2-28 per 100k
mortality 12%
pathophysiology of Acute pancreatitis
activation of zymogen granules –> release proteases that digest pancrease and surrounding tissue
Complications of Acute pancreatitis
in 20%
necrosis, pseudocyst, abscess, multi-organ failure
Causes of acute pancreatitis
Idiopathic 3 Gallstones (commonest) 1 Ethanol (alchohol) 2 Trauma Steroids Mumps Autoimmune/tumour Scorpion Hyperlipidaemia/hypercalcaemia ERCP (endoscopic-retrograde cholangiopancreatography) 4 Drugs (diuretics, corticosteroids, azathiprine)
Symptoms of acute pancreatitis
gradual or sudden severe epigastric/central abdominal pain radiating to the back (in65%) radiates to the back and made better if leaning forward. vomiting is common
Signs of acute pancreatitis
tachycardia
fever
jaundice
shock
paralytic ileus (quiet bowel sounds)
local/general tenderness
cullen’s/grey turner’s signs
Investigations in acute pancreatitis
Serum Amylase, serum lipase is more specific and sensitive
ABG - oxygenation and acid-base status
AXR
CXR - exclude perforation
CT - standard assessment of severity MRI better
US - pancreatic swelling or gallstones
ERCP
CRP >150 predictor of severe pancreatitis
How to assess severity of acute pancreatitis
PO2 Age Neutrophelia Calcium Renal funciton Enzymes Abuminaemia Sugar
3 or more within 48hrs suggests severe
How to manage acute pancreatitis
Nill by mouth - NG tube
IVI - lots of 0.9saline
aim urine flow >30ml/hr
Analgesia - pethidine or morphine
hourly obs
daily FBC, U&E, Ca, glucose, amylase, ABG
ITU if progressive
O2 if low O2
ERCP
Repeat imaging
What is an important blood test in pancreatitis?
CRP
what is pethidine
it is a synthetic morphine like opioid
