Pancreatitis Flashcards
Endocrine function of the pancreas
Endocrine- islets of langerhans, make:
glucagon, insulin, somatostatin and gastrin.
Exocrine function of pancreas
Pancreatic acinar cells produce pancreatic enzymes (lipase, colipase, amylase and protease), pass via the pancreatic duct into the duodenum.
What is acute pancreatitis?
Self perpetuating pancreatic inflammation due to enzyme mediated auto-digestion.
Extracellular fluid is trapped in the gut, peritoneum and retroperitoneum causing oedema and fluid shifts, causing hypovolaemia
Pathogenesis of acute pancreatitis
Marked elevation of intracellular calcium leads to activation of intracellular proteases and the release of pancreatic enzymes.
Acinar cell injury and cell necrosis follows.
This promotes the recruitment of inflammatory cells
local inflammatory response +- systemic inflammatory response—> multiple organ failure.
Aetiology of acute pancreatitis (GET SMASHED)
Gall stones
Ethanol (alcohol)
Trauma
Steroids Mumps Autoimmune Scorpion venom Hyperlipidaemia/ Hypercalcaemia ERCP (endoscopic Retrograde Cholangio-Pancreatography) and emboli Drugs
Acute pancreatitis clinical symptoms?
Severe epigastric/ central abdominal pain
Radiating to back
Sitting forward may relieve pain
Vomitting prominent
Acute pancreatitis signs
Septic shock: tachycardia, fever, jaundice
Rigid abdomen +- local tenderness
Umbilical bruising (Cullen’s sign) or flanks (Grey Turner’s sign) from hemorrhagic pancreatitis (rare)
What are the 3 classifications of acute pancreatitis?
Oedematous
Severe/ necrotising
Haemorrhagic
Diagnostic tests and results for acute pancreatitis
Pancreatitis is diagnosed on the basis of 2 out of 3 of the following criteria:
Severe epigastric pain radiating tot he back
Serum amylase of >1000 U (serum lipase is more sensitive and specific to pancreatitis)
Abdominal CT scan pathology
Also USS may show gall stones
AXR – no psoas shadow (increased retroperitoneal fluid), sentinel loop of proximal jejenum from ileus (solitary air-filled dilatation)
What is typically shown on an abdominal CT scan in acute pancreatitis?
loss of fat planes
pancreatic oedema and swelling
+/- fluid loculations
Glasgow scoring system, Scoring system of severity for acute pancreatitis. What is it? (Pancreas)
(A score of over 3 indicates need for ITU and a poor prognosis)
PaO2 < 8KPa Age > 55 Neutrophils > 15x10to the 9 / L Calcium < 2mmol (low serum cos high intracellular) Raised urea > 15mmol/L Elevated enzymes LDL and AST Albumin < 32g/L Sugar- serum glucose > 15mmol/L
Treatment for acute pancreatitis
Analgesia- pethidine or morphine
Catheterise- ABCDE approach to shock
Nil by mouth- nasogastric tube decreases pancreatic stimulation
IV fluids and nutrients
Drainage of collections may be required
Antibiotics (usually metronidazole) if drain inserted culture to ensure correct spectrum
What are the two main complications of acute pancreatitis
Systemic inflammatory response syndrome
Multiple organ response syndrome
Systemic inflammatory response syndrome is a pro inflammatory state that does not include a documented source of infection. How is it defined
2 or more of the following signs: Tachycardia >90 Tachypnoea >20 Pyrexia >38 (or hypothermia) WCC > high
What is multiple organ response syndrome?
Sequelae of SIRS causing loss of body homeostatic mechanisms
