Pancreatitis Flashcards

1
Q

What is pancreatitis

A

Inflammation of the pancreas

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2
Q

Clinical presentation of acute pancreatitis

A

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.

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3
Q

Pathophysiology of acute pancreatitis

A

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.

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4
Q

Aetiology of acute pancreatitis

A
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

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5
Q

Epidemiology of acute pancreatitis

A

150-452/1 mil

Increasing

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6
Q

Diagnosis of acute pancreatitis

A

Serum amylase: 3x more than normal.

Lipase levels rising more sensitive.

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7
Q

Treatment of mild acute pancreatitis

A

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

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8
Q

Treatment of severe acute pancreatitis

A

IV antibiotics if necrotising, feed with enteral nutrition. Monitor for complications.

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9
Q

Complications of acute pancreatitis

A
HDAMN:
Haemorrhage
Disseminated intravascular coagulation
Acute respiratory distress syndrome (ARDS)
Multiorgan failure
Necrosis
others:
Pancreatic abscess (may require surgery)
Recurrence
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10
Q

Clinical presentation of chronic pancreatitis

A
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).
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11
Q

Subtypes of chronic pancreatitis

A

Large and small duct pancreatitis

Small duct tends not to be associated with calcification

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12
Q

Pathophysiology of chronic pancreatitis

A

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.

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13
Q

Aetiology of chronic pancreatitis

A
CAMP:
Cystic fibrosis
Alcohol
Malnourishment
Pancreatic duct obstruction
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14
Q

Epidemiology of chronic pancreatitis

A

3/100,000 but rising

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15
Q

Diagnosis of chronic pancreatitis

A

Xray/CT: Displays calcification (not valid in small duct)

Secretin stimulation test: Detects if pancreatic exocrine function is damaged.

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16
Q

Treatment of Chronic pancreatitis

A

Pain relief.
Cessate alcohol.
Replace pancreatic enzymes (aids functionality and pain by down regulating release of pancreatic enzymes)
Surgery: Local resection to aleviate duct dilatation/duct stones

17
Q

Complications of Chronic pancreatitis

A
PODS:
Pseudocysts
Obstruction (pancreatic)
Diabetes mellitus
Steatorrhoea
18
Q

Conservative treatment of chronic pancreatitis

A

Alcohol cessation

19
Q

Medical treatment of chronic pancreatitis

A

Analgesics e.g. tramadol and pancreatic enzyme replacement therapy
Start insulin therapy if diabetes has developed

20
Q

What is acute pancreatitis

A

Inflammation of the pancreatic parenchyma, with biochemical associations of increased amylase and raised lipase enzymes on blood test.

21
Q

What is chronic pancreatitis

A

Where the structural integrity of the pancreas is permanently altered as a direct result of chronic inflammation.

22
Q

Acute pancreatitis investigations

A

Raised serum amylase and lipase
Detect cause e.g. ultrasound scan to detect presence of gallstones
CT scan to rule out complications (not within <72h of acute presentation unless clinically indicated)

23
Q

Chronic pancreatitis investigations

A

Decreased faecal elastase
CT scan - shows calcification (may also be seen on abdominal X-ray)
Magnetic resonance cholangiopancreatography (MRCP)