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Met3A > Pancreatitis > Flashcards

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
Q

What are the late complications of acute pancreatitis?

A 
Pancreatic necrosis
Peripancreatic fluid collections 
Pseudocyst 
Abscesses
Bleeding
Thrombosis
Fistulae
Recurrent oedematous pancreatitis
26
Q

Pseudocyst presentation

A

Typically 4 weeks or more after an attack of acute pancreatitis
Pain, fever, palpable mass
Mild elevation of amylase

27
Q

What is chronic pancreatitits?

A

Glucose intolerance, pancreatic insufficiency, calcifications due to chronic scarring/recurrent attacks of acute pancreatitis

28
Q

How is pancreatitis managed?

A 
NBM + NJ feeding
IV fluids
Analgesia + anti-emetic 
Antibiotics (if needed)
Surgery (if needed)
29
Q

Indication for abx in pancreatitis?

A

If nectrotising to prevent becoming infected
If signs/symptoms/lab tests indicate infection
If associated cholangitis or acute infections

30
Q

Role of surgery?

A

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

Met3A (5 decks)

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