Pancreatitis Flashcards
What is acute pancreatitis
Rapid onset inflammatory process
What is chronic pancreatitis
Progressive inflammation and destruction of pancreatic secretory cells
Symptoms of acute pancreatitis?
Severe epigastric pain, radiating to back
Allieviated by sitting forward
Nausea, vomiting, anorexia
Signs of acute pancreatitis
Raised amylase/ lipase High HP, temperature, low BP Abdo distension Mild jaundice Bruised umbilicus/ flanks PATIENT WILL PROBS BE CURLED UP
What does ‘GET SMASHED’ stand for?
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion Bites Hyperlipidaemia, hypercalcaemia ERCP Drugs (thiazide diuretics)
How is a diagnosis of acute pancreatitis reached?
2/3 of:
- Typical symptoms
- Pancreatic enzymes more than 3* upper limit of normal
- Radiographic evidence
What scale is used to determine the severity of pancreatitis?
Glasgow score
Using the correct acronym, state the glasgow score
P- p02<8kpa A- age >55 N- neutrophils >15 C- Calcium <2 R- Renal function >16 E- eNYMES AST>200 A- Albumin <32 S- Sugar >10
Describe mild acute pancreatitis
- No organ failure
- No local or systemic complications
- <3 on Glasgow scale
Describe moderate pancreatitis
- Transient organ filure
- Local complications
Describe severe pancreatitis
- Persistent organ failure >48 hours
- >3 of glascow score
Describe the pathophysiology of acute pancreatitis
- Self- perpetuating pancreatic inflammation by enzyme mediated autodigestion
- Oedema and fluid shifts causing hypovolemia- extracellular fluid trapped in the gut
What are the signs and symptoms of chronic pancreatitis
Symptoms: pain, nausea and vomiting, malabsorption leading to weight loss and steatorrhoea
Signs: Low BMI, abdo pain
What sign in a stool sample would suggest chronic pancreatitis
Low elastase
What is cullens sign
Periumilical bruising
What is grey-turners sign
Flank bruising
What signs on an abdominal x-ray would suggest pancreatitis
No psoas shadowing
What does an Ct show
Pancreatic necrosis
Why may an USS be ordered in pancreatitis
To see any gallstones
Name the acute complications of pancreatitis
- Intrabdominal haemorrhage
- Pancreatic necrosis
- Biliary obstruction
- Multi organ failure
What is a sign of pancreatic necrosis
Peritonitis
What are the late complications of pancreatitis
- Pancreatic pseudocyst
- Pancreatic pseudoaneurysm
- Abscess
- Ascites
What information is provided by the Ranson and Glasgow scores?
Prognosis
What information is provided by the Atlanta criteria
Severity
In what 3 cases would you treat pancreatitis with antibiotics?
- Other signs of infection
- Pseudocyst turned abscess
- Necrotising pancreatitis
What are the steps in treating/ managing pancreatitis
- NBM
- Analgesia
- Fluid rescusitation
What treatment is there for abscess of pancreatic necrosis
- Laparatomy
- Paraenteral nutrition
- Debridgement
- Abx
When would ERCP be suggested in pancreatitis
If there is progressive jaundice
How would you treat chronic pancreatitis
Enzymes
