pancreatitis Flashcards
what questions do you ask when someone comes in
What is the diagnosis?
How sick is he?
What is the underlying cause?
definition of acute pancreatitis
an acute inflammatory process that leads to the necrosis of pancreatic parenchyma
signs of acute pancreatitis
severe abdominal pain, nausea, vomiting, diarrhoea, fever, and shock
signs of shock
high pulse
low BP
describe capillary refil time
blood flow back into hands
should be <2s
diagnostic approach
History Examination Tests: SIMPLE BLOOD TESTS - Straight forward blood tests – everyone gets when come in COMPLEX BLOOD TEST SIMPLE IMAGING CROSS SECTIONAL IMAGING - CT INVASIVE TEST
basics first = more differentials
where is anylase produced
pancreas
salivary glands
why would white cell count be raised
infection
severe inflammation
what is ALT
alanine transferase
marker of hepatocyte function
albumin test
if low - something going on
the lower it is the worse the issue is
what is ALP
alkaline phosphatase
lines sinusoids
CT with pancreatitis
Inflammation tracking to retroperitoneal spaces and umbilicus
Magnetic resonance cholangiopancreatography
look at blockage in bile ducts – consider if no obvious cause
describe ERCP
Endoscopic retrograde cholangiopancreatography
cannular all the way down
wire into bile duct through ampulla of Vater - inject dye and take X ray
scoring systems for a pancreatitis
Ranson’s – alcoholic cause
APACHE II – anaesthesia for surgery
SIRS – inflammation
describe SIRS scoring
temp - >38 <36
HR >90beats/min
resp rate >20 breaths/min or PaCO2 <32mmHg
WBC >12000cells/mL or <4000cells/mL - Low white cell count – first sign of inf – all taken to one point before bone marrow can make more
Ranson score
age >55 wbc >16000 blood glucose >11.1mmol/L LDH >350U/L aspartate amino transferase >250UU/L haematocrit fall byb >10% blood urea nitrogen - Increase by ≥1.8 mmol/L despite fluids serum ca <2mmol?l pO2 <60mmHg base deficit >4 fluid sequestration >6L - oedema
risk factor for a pancreatitis
Necrosis vs non necrosis Organ failure Age Co morbidities - Resp failre, malabsorption, gut failure, heart failure Alcohol
aetology of a pancreatitis
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune - getting more common
Scorpion bite
Hyperlipidaemia/ Hypercalcaemia/Hypothermia
ERCP - 2% risk
Drugs (azathioprine, valproate)- not frequent but recognisable
systemic complications of a pancreatitis
Hypovolaemia - fluid gone elsewhere
Hypoxia - fluid affectring lung
Hypocalcaemia
Hyperglycaemia - decreased insulin release
DIC - all clotting controllers go to gut = uncontrollable bleeding
Multiple organ failure
localised complications of a pancreatitis
Pancreatic necrosis- dies
Fluid collections – mature into pseuduocysts - pressure defects - pain and discomfort - vomiting and difficulty swallowing
Splenic vein thrombosis/pseudoaneurysm- systemic portal hypertension
Chronic Pancreatitis
treatment of a pancreatitis
Supportive:
Fluids
Painkillers
Nutrition - feeding into gut better then veins if not very unwell
Organ Support
Management of complications
Support bp – ionotropes – improve venous return to heart
definition of chronic pancreatitis
progressive fibroinflammatory process of pancras - permenant structural damage - impairment of exocrine/.endocrine function
complication of c pancreatitis
Malabsorption -Loss of 90% exocrine function - Fat soluble vitamin malabsorption
symptoms of c pancreatitis
severe weight loss, ab pain, watery diarrhoea
investigation of chronic pancreatitis
Plain Xray - calcification in pancreas, V ueful sign, confirmed on Ct - dilation of pancreatic ducts
CT scan
Faecal elastase- nzymes released by panc - marker for rest - measured in faecal sample - if low correct
management of chronic pancreatitis
Stop alcohol and smoking
Small meals with low fat - it affects gastric emptying
PPI – reduce acidity in stomach – so doesn’t reduce the effect of enxymes
and pancreatic supplements
Analgesia - reduce pain
