Pancreatitis Flashcards
What are the causes of pancreatitis?
GET SMASHED: Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bites Hypercalcaemia/hyperlipidaemia ERCP Drugs (e.g. azathioprine)
What are the different types of pancreatitis and how common is each one?
Oedematous - 70%
Severe/Necrotising - 25%
Haemorrhagic - 5%
What are the clinical features of pancreatitis?
Acute constant epigastric pain, radiating through to the back. Aggravated by movement, relieved by sitting up.
Associated with N&V (due to visceral pain).
Tachycardia and hypotension.
Tenderness and guarding.
What specific signs may hemorrhagic pancreatitis show?
Cullen’s sign (peri-umbilical bruising).
Grey-Turner’s sign (flank bruising).
Describe the process by which pancreatitis occurs.
Ductal obstruction -> Interstitial oedema -> Impaired blood flow -> Ischaemia -> Acinar cell injury.
Acing cell injury affects protease and elastase (digestion of blood vessel walls leads to haemorrhage), lipases (abdo fat necrosis - released fatty acids bind Ca2+ - hypocalcaemia) and destructs islet cells (hyperglycaemia), all of which act to cause an infection and the formation of abscess and cysts.
How is pancreatitis diagnosed?
Raised serum amylase (not specific, also raised in renal failure, ectopic pregnancy and DKA).
Raised serum lipase (specific, but doesn’t rise until 8hrs after symptom onset).
USS to check for gallstones, may show swollen necrotic pancreas.
CT to look for pancreatic oedema.
How is pancreatitis managed?
IV fluids.
Analgesia.
Anti-emetic.
Treat for sepsis if indicated.
What are the possible complications of pancreatitis?
Abscess, sepsis, ARDs.
What are the causes of chronic pancreatitis?
Alcohol, Autoimmune, Genetic.
What are the symptoms of chronic pancreatitis?
Pain 15-30 mins after eating, steatorrhoea, diabetes mellitus. Also get pancreatic calcification.
What are the risk factors for chronic pancreatitis?
Smoking, alcohol, female, middle aged, family history.
What are the possible complications of chronic pancreatitis?
Pseudocysts, sepsis, cancer.
What does the Glasgow Scoring System for pancreatitis consist of?
P - pO2 < 7.9kPa A - Age > 55 N - Neutrophils (WBC > 15) C - Ca2+ < 2mmol/L R - Renal urea > 16mmol/L E - Enzyme LDH > 600iu/L A - Albumin < 32g/L S - Sugar > 10mmol/L 3 OR MORE INDICATES SEVERE.
