Pancreatitis Flashcards
What happens in acute pancreatitis?
There is activation of pancreatic enzymes within the pancreas. This causes necrosis and haemorrhage due to digestion of blood vessels
What happens in chronic pancreatitis?
There is long standing inflammation of the pancreas that causes damage and impair endocrine and exocrine functions of the pancreas
What are the leading causes of acute pancreatitis?
Gallstones Ethanol Trauma Steroids Mumps Auto-immune Scorpion sting Hypertriglyceridemia, Hypercalcaemia, Hypothermia ERCP Drugs- Esp HIV drugs
What are the symptoms of acute pancreatitis?
Severe epigastric abdominal pain that radiates to the back
Nausea and vomiting
Abdominal tenderness
Severe cases cause hypovolemic shock, (hypotension, tachypnoea and hypotension)
What is Cullen’s Sign?
Bruising discolouration around the umbilicus
What is Grey Turner’s Sign?
Bruising discolouration at the flanks
What does Cullen’s Sign and Grey Turner Sign indicate?
Retroperitoneal haemorrhage due to vessels being eroded
What might be seen with Mumps pancreatitis?
Swollen parotid glands
What is test can be done to confirm the diagnosis?
Serum Lipase- most sensitive
Serum Amylase- less sensitive
Note- amylase is not prognostic
What is the most sensitive test for acute pancreatitis?
Serum lipase- rises within 8 hours and returns to normal within 14 days
What scoring system is used to estimate prognosis and severity?
Glasgow Score- assess prognosis and risk of mortality
PaO2 less than 8 Age greater than 55 Neutrophils >15 Calcium <2 Renal Function Urea>16 Enzymes (AST/ALT >200 or LDH>600) Albumin <32g/L Sugar (Glucose>10 mmol/L)
Why are calcium levels low in pancreatitis?
Fat necrosis consumes glucose
What investigations might be done for suspected acute pancreatitis?
Abdominal USS- May reveal gallstone in the pancreatic duct
CT with Contrast
Abdominal X-Ray
What is the management for acute pancreatitis?
Supportive-
IV Fluid Resus
Analgesia- Opioids
Parenteral nutrition if required
Manage the causes
