Pancreatitis Flashcards
What type up organ is the pancreas?
Retroperitoneal
What are the anatomical relations of the pancreas?
Tail of pancreas close to the spleen Head enveloped by duodenum Bile duct running through head of pancreas before duodenum Stomach anterior to it Transverse colon inferior to it
Pancreatic ducts empty where
Into duodenum at ampulla of Vater at same place of bile duct
Exocrine function of the pancreas
- proteases
- lipases
- amylase
- phospholipases
Cells in pancreas?
Acinar cells
Ductal cells
Islets of Langerhans
Role of acinar Cells
Produce proteases, lipases, amylase, phospholipases
Role of ductal cells
Produce pancreatic Juice
Role of islets of langerhans
Endocrine
- contains beta cells producing insulin and alpha cells producing glucagon
Endocrine function of the pancreas
Produces insulin, glucagon, somatostatin
What is pancreatic juice?
HCO3- = neutralises acid from stomach
2L per day
Brought into duodenum via pancreatic duct along with exocrine enzymes
Causes of acute pancreatitis
Gallstones blocking pancreatic duct Alcohol Hypertriglyceridemia Hypercalcaemia Drugs (steroids, azathioprine, thiazides, anti-retrovirals, valproate) Trauma/hypothermia Iatrogenic (ERCP) Genetic (CFTR) Autoimmune pancreatopathy (IgG4)
Presentation of acute pancreatitis
Abdominal pain central
Radiates to back
High serum amylase and lipase
Multi organ or systemic dysfunction
Scoring systems for pancreatitis severity
Glasgow
Ranson
APACHE II
Management of acute pancreatitis
Aggressive fluid resus - 1-2L bolus - 250-300ml/h - titrate to UO Analgesia - opoid based Empirical ABs - not everyone - if >30% necrotic pancreas, max 14 days Nutrition - enteral feed early - may need to be nasojejunal Complications - sepsis management - cystgastrostomy Later - cholecystectomy - alcohol cessation
Is intensive care needed for acute pancreatitis management?
Some patients - ITU
- SIRS/organ failure
- for mechanical ventilation, hemofiltration, ionotropes
