Pancreatitis Flashcards
what are the 4 stages of acute pancreatitis?
- release of pancreatic enzymes
- auto digestion of the pancrease and surrounding tissues
- progresses to blood vessel autodigestion
- pancreas becomes necrotic
what are the 2 main causes of pancreatitis?
gallstones and alcohol
how does acute pancreatitis present?
sever epigastric pain- can radiate to the back
NV
what are some signs of acute pancreatitis?
jaundice
Grey-turners sign
cullens sign
name three scoring systems used in pancreatitis
Modified glasgow criteria
Ranson’s criteria
APACHE II score
what are the 6 aims of acute pancreatitis management?
resuscitation (A-E)
Treat pain
Early risk stratification
Rest the pancreas (via nutritional support)
treat the cause (e.g. ERCP within 72 hrs for gallstone disease)
treat compliations
what are the complications of acute pancreatitis?
Infection ARDS hyperglycaemia (insulin sliding scale) hyper or hypocalcaemia alcohol withdrawal- chlordiazepoxide pancreatic necrosis
what is a pancreatic pseudocyst?
collection of pancreatic fluid in the lesser sac surrounded by granulation tissue (occurs 4-6weeks post acute pancreatitis attack)
presents with persistent abdominal pain, epigastric mass and early satiety
if <6cm it will resolve spontaneously
if >6cm it will require percutaneous drainage under USS?CT
describe chronic pancreatitis
chronic inflammation of the pancreas characterised by fibrosis, destruction of exocrine and endocrine tissues and chronic pain
what is the main cause of chronic pancreatitis?
alcohol (60-70%)
what physiological effects does chronic pancreatitis have?
loss of exocrine function–> malabsorption (vit deficiencies, iron def anaemia, fatty stools, wt loss)
loss of endocrine function–>Diabetes mellitus
how does chronic pancreatitis present?
chronic epigastric pain (radiating to the back, relieved by sitting back or by a hot water bottle) –>beware of erythema ab igne due to the hot water bottle
- the pain is also exacerbated by fatty foods
steatorrhoea
wt loss
Diabetes mellitus
what are some important tests to do in chronic pancreatitis?
Glucose tolerance test
faecal elastase (for diagnosis or exclusion of pancreatic exocrine insufficiency)
FBC, U+E, LFTs, INR, CRP, Amylase
suggest 3 types of imaging useful in chronic pancreatitis and what you would expect to find?
USS- pancreatic pseudocyst
AXR- speckled pancreatic calcification
CT- pancreatic calcification
what does an MRCP provide info on?
on the structure and anatomy of the pancreatic parenchyma, ductal system and biliary tree
What are the 4 aims of chronic pancreatitis management?
- discontinuation of alcohol and managing the withdrawal with chlordiazepoxide
- pain management using the WHO pain ladder
- managing the malnutrition/malabsorption with replacement vitamins etc
- Treat the diabetes mellitus e.g. Insulin
what are the indications for surgery in chronic pancreatitis?
unrelenting pain
wt loss
what are some surgical options for chronic pancreatitis?
pancreatectomy
pancreatic duct stunting
stone removal from pancreatic ducts
puestow procedure (longitudinal pancreaticojenunostomy)
what are some complications of chronic pancreatitis?
pseudocyst pancreatic cancer Diabetes mellitus biliary obstruction splenic vein thrombosis-->splenomegaly
what medication used in UC can increase your risk of acute pancreatitis?
mesalazine
