Pancreatitis Flashcards

1
Q

What are the causes of pancreatitis?

A

I GET SMASHED

Idiopathic
Gallstones (35%)
Ethanol (35%)
Trauma
Steroids
Mumps
Autoimmune e.g. SLE, Sjogren's 
Scorpion venom
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP 
Drugs (furosemide, oestrogens, azathioprine, thiazide diuretics, tetracyclines)
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2
Q

What are the most common causes of acute pancreatitis?

A

Gallstones and alcohol (account for 70% together)

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3
Q

What are the symptoms of acute pancreatitis?

A

Severe epigastric pain (may radiate to the back, sitting forward may relieve)
Vomiting
Anorexia

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4
Q

What are the signs of acute pancreatitis?

A
Tachycardia, fever, shock
Jaundice
Reduced bowel sounds (ileus)
Rigid abdomen and local/general tenderness
Cullen's sign (rare)
Grey Turner's sign (rare)
Signs of hypovolaemia
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5
Q

What is Cullen’s sign?

A

Peri-umbilical bruising

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6
Q

What is Grey Turner’s sign?

A

Flank bruising

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7
Q

What are the differentials of acute pancreatitis?

A
Perforated viscus
Oesophageal spasm 
AAA
Intestinal obstruction
Ascending cholangitis
Gallstones
Cholecystitis 
Viral gastroenteritis
Hepatitis 
Mesenteric ischaemia 
MI
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8
Q

What bloods are done in acute pancreatitis?

A
FBC
U+E 
LFT
Amylase
Lipase
CRP
ABG
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9
Q

Amylase vs lipase?

A

Amylase - raised, around 3x ULN

Lipase - more sensitive and specific, rises earlier and falls later

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10
Q

Signs on AXR

A

Colon cut-off sign (gas distending the R colon stops abruptly in the mid or left transverse colon)
Calcifications
Sentinel loop of proximal jejunum from ileus
No psoas shadow

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11
Q

What is the standard choice of imaging in acute pancreatitis?

A

CT

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12
Q

Atlanta criteria - mild acute pancreatitis?

A

No organ failure or local/systemic complications, usually resolves in 1st week and doesn’t need CT, lower mortality

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13
Q

Atlanta criteria - moderately severe acute pancreatitis?

A

Transient organ failure (resolves within 48 hours), and/or local or systemic complications

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14
Q

Atlanta criteria - severe acute pancreatitis?

A

Persistent organ failure (>48 hours)

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15
Q

What is Ranson’s criteria used for?

A

Estimates mortality of patients with pancreatitis, calculated at admission and at 48 hours.

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16
Q

What does Ranson’s score mean?

A

1-2 = severe panc. unlikely

3 or more = likely, consider ITU

17
Q

What are Ranson’s criteria? (11)

A
WBC >16K
Age >55
Glucose >10mmol/l
AST > 250
LDH > 350

48 hours into admission, it includes Hct, BUN, calcium, arterial p02, base deficit, and fluid needs

18
Q

What does Glasgow score comprise of?

A
Pa02 <8kpa
Age >55 
Neutrophillia >15x10 to the 9/L
Calcium <2
Renal function (urea) >16
Enzymes - LDH >600, AST >200
Albumin <32
Sugar >10
19
Q

Why is Glasgow score better than Ransons?

A

Ranson you have to wait at least 48 hours before you can apply the score

20
Q

When would a Glasgow score consider transfer to ITU/HDU?

A

If 3 or more positive factors within 48 hours

21
Q

What is the pathophysiology of pancreatitis?

A

Inactive pro-enzymes that are released by pancreas and activated in the small intestine, are activated early (e.g. due to gallstones blocking the release of pancreatic juices)
–> autodigestion of the pancreas
–> inflammatory cytokines and neutrophils recruited
–> causes blood vessel leaks and rupture, causing swelling
Lipases destroy peripancreatic fat
Digestion and bleeding can liquefy tissue

22
Q

What are the early complications of acute pancreatitis?

A
Shock
ARDS
Renal failure
DIC
Sepsis
Hypocalcaemia
Hyperglycaemia
23
Q

Why do you get ARDS with acute pancreatitis?

A

excretion of inflammatory mediators may damage the alveolocapillary membrane, leading to destruction of pneumocytes and decrease the amount of surfactant.

24
Q

Mechanism of hypocalcaemia in acute pancreatitis?

A

Lipases release free fatty acids, these chelate the calcium salts in the pancreas and cause soaps to form

25
What are the late complications of acute pancreatitis?
``` Pancreatic necrosis Peripancreatic fluid collections Pseudocyst Abscesses Bleeding Thrombosis Fistulae Recurrent oedematous pancreatitis ```
26
Pseudocyst presentation
Typically 4 weeks or more after an attack of acute pancreatitis Pain, fever, palpable mass Mild elevation of amylase
27
What is chronic pancreatitits?
Glucose intolerance, pancreatic insufficiency, calcifications due to chronic scarring/recurrent attacks of acute pancreatitis
28
How is pancreatitis managed?
``` NBM + NJ feeding IV fluids Analgesia + anti-emetic Antibiotics (if needed) Surgery (if needed) ```
29
Indication for abx in pancreatitis?
If nectrotising to prevent becoming infected If signs/symptoms/lab tests indicate infection If associated cholangitis or acute infections
30
Role of surgery?
If gallstones --> early cholecystectomy Obstructed biliary system due to stones --> early ERCP Fail to settle with necrosis and are worsening --> debridement or fine needle aspiration Infective necrosis --> radiological drainage or surgical necrosectomy