pancreatitis Flashcards
divided into
acute and chronic
can acute return to normal
yes
what is seen in chronic pancreatitis
continuing inflammation with irreversible structural damage
is chronic pancreatitis reversible
no
what is acute pancreatitis
inflammation of the pancreatic gland initiated by any acute injury
what are most common causes of acute
- gallstones
- alcohol
causes of acute
I GET SMASHED
- idiopathic
- gallstone
- ethanol (alcohol)
- trauma
- steroids
- mumps
- autoimmune
- scorpion sting
- hypercalcaemia
- ERCP
- drugs
how can gallstone cause pancreatitis
by obstructing to pancreatic drainage at the ampulla by a stone
what happens pathologically in gallstone pancreatitis
- trypsinogen is cleaved to trypsin
- trypsin is degraded by chmotryspin C is impaired
- intracellular calcium increases
- increased calcium causes more trypsinogen
- acinar cell damage
what does alcohol interfere with in pancreatitis
calcium homeostasis in pancreatic acinar cells
what does alcohol activate in pancreas
pancreatic stellate cells by acetylaldehyde
what do pancreatic stellate cells produce
collagen and matrix proteins
where is the pain in acute
upper abdominal
symptoms of acute
- epigastric pain
- nausea
- vomiting
- pain spreads to back
- previous gallstones
- alcoholic binge
- tachycardia
- hypotension
signs of acute
- absent bowel sounds
- Cullens sign
- Grey Turners (bruising)
what investigations are done for acute
- serum amylase
- urinary amylase
- serum lipase
- CRP level
- CXR
- ultrasound
- CT
- MRCP
is serum amylase a sensitive test
yes
what are other causes of elevated serum amylase
- upper GI perforation
- peritonitis
is urinary amylase diagnostic
yes
are serum amylase levels elevated for a long time
no
what is CRP level useful for
severity and prognosis
what is a mandatory investigation
CXR
why is a CXR done
to exclude gastroduodenal perforation - this also raises serum amylase
what is ultrasound used for
to identify a possible gallstone
what is ERCP used for
treatment measure to remove bile duct stones
what is required early for treatment for acute
- IV fluids
- urinary catheter
to monitor circulating volume and renal function
what does nasogastric suction do
prevents abdominal distension and vomitus
= reduces risk of aspiration pneumonia
treatment methods of acute
- antibiotics
- analgesia
- feeding
- anticoagulation
why is anticoagulation given
LMWH heparin is given for prophylaxis of DVT
what is treatment of gallstone pancreatitis
endoscopic intervention with sphincterotomy and stone extraction
how else can stones be removed
by ERCP
complications of acute pancreatitis
- SIRS
- necrosis
- abscess
- pleural effusion
- pneumonia
- GI bleed
- hypoglycaemia
what is the cause of chronic
alcohol
pathology of chronic
an increase in activated trypsin within the pancreas
what cells produce chymotrypsin C
acinar cells
what does chymotrypsin C do
inactivate trypsin
where is CFTR
apical surface of the acinar cells
how many types of autoimmune chronic pancreatitis
2
who is most likely to get type 1 ACP
middle aged men
what causes type 1 ACP
IgG 4 lecels
can type 1 ACP spread
yes
can type 2 ACP spread
no
symptoms of chronic
- epigastric pain
- pain radiates to back
- anorexia
- weight loss
- malabsorption
- diabetes can occur
- steatorrhoea
what can exacerbate pain in chronic
alcohol
investigations for chronic
- serum amylase and lipase
- serum IgG4 levels
- faecal elastase
- gene mutation
- ultrasound
- CT
- MRI with MRCP
what are serum amylase and lipase levels
elevated
what is ultrasound useful for
initial analysis
what does CT enhance
more detail
- presence of pancreatic calcification
- dilated pancreatic duct
what has MRCP replaced
ERCP
differential diagnosis of chronic
pancreatic malignancy
treatment for abdominal pain in chronic
- NSAIDs
- opiate
- ## tricyclic antidepressants
can patients become pain free
yes after 6-10 years
why does patient get steatorrhoea
due to malabsorption
how to treat malabsorption in chronic
pancreatic enzyme supplements
is associated diabetes easy to control
no
treatment for autoimmune pancreatitis
glucocorticoid therapy e.g. prednisolone
complications of chronic
- pancreatic pseudocyst
- ascites
- pleural effusions
- pancreatic cancer
what is pancreatic pseudocyst
fluid collection surrounded by granulation tissue
dangers of larger cysts
may occlude nearby structures including duodenum
