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MRCS med school > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Pathophysiology of acute pancreatitis

A

pancreatic enzymes released & activated in vicious circle

  1. oedema + fluid shift + vomiting -> hypovolaemic shock & autodigestion by enzymes and fat necrosis
  2. vessel autodigestion -> retroperitoneal haemorrhage
  3. inflammation -> pancreatic necrosis
  4. super-added infection (50% pts with necrosis)
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2
Q

epidemiology of acute pancreatitis (age, mortality rate)

A

4th & 5th decades

10% mortality

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3
Q

causes of acute pancreatitis

A

GET SMASHED

gallstones (45%)

ethanol (25%)

idiopathic (20%)

trauma

steroids

mumps

autoimmune

scorpion

hyperlipidaemia

ERCP (5% risk)

drugs (thiazides, azathioprine)

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4
Q

symptoms of acute pancreatitis

A

severe epigastric pain -> back (maybe relieved on sitting forward)

vomiting

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5
Q

signs of acute pancreatitis

A

shock

epigastric tenderness

jaundice

ileus

ecchymoses

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6
Q

Grey turners

A

flank bruise

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7
Q

Cullens

A

periumbilical

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8
Q

Severity of acute pancreatitis

A

1 = mild

2 = mod

3 = severe

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9
Q

Criteria for severity of pancreatitis

Glasgow severity score

A

PaO2 <8kPa

Age >55yrs

Neutrophils >15 x109/L

Ca2+ <2mM

Renal function U>16mM

Enzymes LDH>600iu/L, AST>200 iu/L

Albumin <32g/L

Sugar >10mM

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10
Q

blood tests for acute pancreatitis

A

↑amylase (>1000 / 3x ULN)

↑lipase

LFTs: cholestatic picture, ↑AST, ↑LDH

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11
Q

urine test for acute pancreatitis

A

Urine: glucose, ↑cBR, ↓urobilinogen

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12
Q

Imaging for acute pancreatitis

A

USS

CXR: ARDS

DUAXR: sentinel loop, pancreatic calcification

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13
Q

USS findings for acute pancreatitis

A

Gallstones

Dilated common bile duct (> 7mm indicates obstruction)

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14
Q

conservative management of acute pancreatitis

A

constant reassessment

fluid resus

pancreatic rest

analgesia

antibiotics

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15
Q

interventional management of acute pancreatitis

A

ERCP- if pancreatitis with dilated ducts secondary to gallstones

  • ERCP + sphincterotomy → ↓ complications
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16
Q

indication for surgical management of acute pancreatitis

A

Infected pancreatic necrosis

Pseudocyst or abscess

Unsure Dx

17
Q

surgical options for acute pancreatitis

A

Laparotomy + necrosectomy (pancreatic debridement)

Laparotomy + peritoneal lavage

Laparostomy: abdomen left open with sterile packs in ITU

18
Q

early complications of acute pancreatitis

A

Respiratory: ARDS, pleural effusion

Shock: hypovolaemic or septic

Renal failure

DIC

Metabolic (↓ Ca2+, ↑ glucose, Metabolic acidosis)

19
Q

late (>1 week) complications of acute pancreatitis

A

Bleeding: e.g. from splenic artery

Thrombosis → portal HTN

Fistula formation (Pancreato-cutaneous → skin breakdown)

20
Q

what is a pancreatic pseudocyst?

A

collection of pancreatic fluid in lesser sac surrounded by granulation tissue (occurs in 20%)

21
Q

presentation of pancreatic pseudocyst

A

4-6wks after acute attack

Persisting abdominal pain

Epigastric mass → early satiety

22
Q

complications of pancreatic pseudocyst

A

Infection → abscess

Obstruction of duodenum or CBD

23
Q

tests for pancreatic pseudocyst

A

Persistently ↑ amylase ± LFTs

US / CT

24
Q

treatment of pancreatic pseudocyst

A

<6cm: spontaneous resolution

>6cm (Endoscopic cyst-gastrostomy, Percutaneous drainage under US/CT)

25
Q

Complications of ERCP

A

Bleeding

Perforation

Pancreatitis

Cholangitis

26
Q

When to use CT scan + contrast for pancreatitis

A

Complications of pancreatitis

27
Q

CT findings for pancreatic necrosis

A

Non enhancing pancreas

28
Q

CT findings for pancreatitis infective necrosis

A

Non enhancing pancreas

+ Bubbles

29
Q

When to use abx for pancreatitis

A

Infective necrosis

30
Q

Effect of Jaundice / biliary disease on clotting

A

Impairs clotting

Vit K fat soluble

Reduced Vit K absorption due to reduced bile following biliary obstruction

MRCS med school (44 decks)

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