Pancreatitis Flashcards
What is pancreatitis
Inflammation of the pancreas
Clinical presentation of acute pancreatitis
PAN:
epigastric or upper abdominal Pain radiating through to the back
Anorexia
Nausea and vomiting
Grey Turners sign - flank bruising
Cullen’s sign - peri-umbilical bruising
Coma and multiple organ failure are possible, and may delay diagnosis.
Pathophysiology of acute pancreatitis
The pancreas releases exocrine enzymes that cause auto-digestion of the organ.
Final common pathway; increased intracellular calcium -> activation of intra-cellular proteases and release of pancreatic enzymes.
This can lead to acinar cell injury and necrosis -> Inflammatory cells and release of mediators and cytokines to produce local inflammatory response.
Can progress to multiple organ failure.
Gallbladder: Gallstones block the bile duct, causing back pressure in the pancreatic duct.
Aetiology of acute pancreatitis
Gallbladder disease and excess alcohol consumption I GET SMASHED: Idiopathic Gallstones Ethanol (alcohol) Trauma Steroids Mumps Autoimmune Scorpion sting Hyperlipidemia ERCP (Endoscopic retrograde cholangio-pancreatography) Drugs e.g. azathioprine
Gallstones and Ethanol are most common
Epidemiology of acute pancreatitis
150-452/1 mil
Increasing
Diagnosis of acute pancreatitis
Serum amylase: 3x more than normal.
Lipase levels rising more sensitive.
Treatment of mild acute pancreatitis
Pain relief/analgesics e.g. tramadol
IV fluids (keep nil by mouth - NBM)
Monitor for complications and treat underlying causes e.g. gallstones
Usually symptomatic relief
Treatment of severe acute pancreatitis
IV antibiotics if necrotising, feed with enteral nutrition. Monitor for complications.
Complications of acute pancreatitis
HDAMN: Haemorrhage Disseminated intravascular coagulation Acute respiratory distress syndrome (ARDS) Multiorgan failure Necrosis others: Pancreatic abscess (may require surgery) Recurrence
Clinical presentation of chronic pancreatitis
Severe epigastric abdominal pain Pain radiating through to the back Recurrent Relieved by sitting forward Worse when eating/drinking heavily
Severe weight loss possible. Diabetes and steatorrhoea (due to insulin and liapse deficiency). Jaundice possible (due to obstruction of the CBD).
Subtypes of chronic pancreatitis
Large and small duct pancreatitis
Small duct tends not to be associated with calcification
Pathophysiology of chronic pancreatitis
Inappropriate activation (possibly prompted by alcohol) of enzymes within the pancreas leads to precipitation of protein plugs within the duct lumen, forming a nidus for calcification.
This leads to ductal hypertension, and therefore pancreatic damage.
In addition to cytokine activation, this causes pancreatic inflammation, morphological change and possible permanent loss of function.
End result is pancreatic fibrosis.
Aetiology of chronic pancreatitis
CAMP: Cystic fibrosis Alcohol Malnourishment Pancreatic duct obstruction
Epidemiology of chronic pancreatitis
3/100,000 but rising
Diagnosis of chronic pancreatitis
Xray/CT: Displays calcification (not valid in small duct)
Secretin stimulation test: Detects if pancreatic exocrine function is damaged.