Pancreatitis Flashcards
Define acute and chronic pancreatitis.
Acute pancreatitis - acute inflammatory process that leads to necrosis of the pancreatic parenchyma.
Chronic pancreatitis - progressive fibroinflammatory process of the pancreas that results in permanent structural damage, which leads to impairment of exocrine and endocrine function.
Recall the causes of acute pancreatitis.
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Venom Hyperlipidaemia/Hypercalcaemia ERCP Drugs
State some symptoms and signs of acute pancreatitis. Name the specific signs.
Epigastric and RUQ pain radiating to the back Nausea Vomiting Diarrhoea Fever Shock
Abdomen tender in the epigastrium
List some useful tests for pancreatitis
Blood tests:
Elevated pancreatic enzymes (amylase/lipase)
Lipase remains elevated longer and is more specific of pancreatitis but it isn’t normally measured
Radiological tests:
Chest X-ray to eliminate possibility of perforated ulcer
Abdominal X-ray - eliminate the possibility of local ileus
Ultrasound
CT - if there is any diagnostic doubt
MRCP
Invasive Tests: ERCP
Faecal elastase test when testing for chronic pancreatitis
What would you expect the amylase and lipase levels of a patient with chronic pancreatitis to be and why?
Normal - due to loss of pancreatic enzyme function
Complications of pancreatitis
Systemic: Hypovolaemia (dehydration) Hypoxia (unable to breathe deeply because of upper quadrant pain) Hypocalcaemia Hyperglycaemia DIC Multiple Organ Failure
Local: Pancreatic necrosis Fluid collections - mature into pseudocysts Splenic vein thrombosis/pseudoaneurysm Chronic pancreatitis
Scoring systems used for pancreatitis?
Ranson’s Criteria
APACHE II
SIRS
2 or more of the following: Temperature >38.3 or <36 Heart rate >90 Respiratory rate >20 or PCO2 <32mmHg WBC >12000 cells/ml or <4000 cells/ml
Treatment for acute pancreatitis
Fluids Painkillers Nutrition Organ support Management of complications
What is the diagnostic approach?
HISTORY
EXAMINATION
TESTS:
Simple, Blood Tests, Complex Blood Tests, Simple Imaging, Cross Sectional Imaging, Invasive Test
Risk factors for severity
Necrosis vs non necrosis Organ failure Age Co-morbidities Alcohol
Features of chronic pancreatitis
Malabsorption - steatorrhea
Loss of 90% exocrine function
Fat soluble vitamin ADEK malabsorption
Management of chronic pancreatitis
Stop alcohol and smoking
Small meals with low fat
PPI and pancreatic supplements
Analgesia
