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Year 3 - Gastro > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Define acute pancreatitis

A

An acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems

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2
Q

Which artery supplies the

A

Coeliac trunk
Superior mesenteric artery
Splenic artery

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3
Q

Where does the bile enter the duodenum?

A

Sphincter of odi

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4
Q

What is the name of the cell that produces enzymatic material in the pancreas?

A

Acinar cell

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5
Q

Aetiology

A

It’s coming home

Ischaemia
Trauma
Scorpion sting
Corticosteroids
Oddi sphincter surgery
Mumps
Iatrogenic (ERCP procedure)
No cause identified (idipathic)
Gallstones
Hyperlipidemia/hypercalcemia
Other (drugs)
Malignancy
Ethanol

OR

I GET SMASHED

Idiopathic
Gallstones
Ethanol toxicity
Trauma

Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcemia and hypertriglycerides
Endoscopic retrograde cholangiopancreatography (ERCP)
Drugs - thiazide, frusemide, oestrogen, azathioprine

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6
Q

Which of these are the most common causes?

A

Gallstones (middle aged/female - due to high oestrogen levels)
Ethanol (male/young person)

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7
Q

Epidemiology

A

Peak age - 60years

V common

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8
Q

Symptoms

A

Severe epigastric pain, radiating to the
Anorexia
Nausea
Vomiting

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9
Q

Signs

A

Epigastric tenderness
Fever
Jaundice
Shock (due to fluid in ‘third space’ therefore (tachycardia/pneoa)
Decreased bowel sounds due to ileus - paralysis of small intestines
Cullen’s sign - periumbilicial
Grey-Turner’s sign - flank

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10
Q

What’s the amylase level like?

A

Very high serum amylase (does not correlate with severity)

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11
Q

Investigations

A 
Very high serum amylase (does not correlate with severity)
High WBC
U&Es (to check for dehydration)
High glucose
High CRP 
Low calcium 
Deranged LFTs
ABGs (for hypoxia or metabolic acidosis)
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12
Q

Why is the calcium low?

A

Due to saponification, where the calcium binds to digested lipids from pancreas, forming a soap)

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13
Q

Why do you get high glucose?

A

Glucagon is released

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14
Q

When do you get deranged LFTs?

A

Gallstone pancreatitis or alcohol ?Obstructive jaundice
GGTs
ALP

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15
Q

Why do you do a CXR?

A

Pleural effusion

to check for bowel performation

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16
Q

Which score is used to assess pancreatitis severity?

A

Modified glasgow score, combined with a CRP level of above 210?

17
Q

Name another score

A

APACHE-2 score

18
Q

Medical management

A

Fluid and electrolytes
Urinary catheter and NG tube if vomiting
Analgesia
Blood sugar control
HDU/ITU
Prophylatic Abx
Nill by mouth to rest bowel, then IV fluids

19
Q

What do you do to manage gallstone pancreatitis

A

ERCP and sphincterectomy

Surgery to manage

20
Q

Local Complications

A 
Pancreatic necrosis
Abscess (e.coli infected)
Pseudocyst (peripancreatitic fluid collection lasting more than four weeks)
Ascites
Pseudoaneurysm 
Venous thrombosis
21
Q

Systemic complications

A 
Hypovolemic shock due to haemorrhage from damaged blood vessels 
Multiorgan failure
Sepsis 
Renal failure
Acute respiratory distress syndrome, due to inflammatory mediators causing alveoli to be dilated 
Prothrombotic factors produced by DIC
Hypocalcemia
Diabetes
22
Q

Prognosis

A

20% severe mortality

Infected necrosis - 70% mortality

23
Q

How does alcohol cause pancreatitis?

A

Alcohol decreases fluids and bicarbonates production from ductal epithelial cells -> pancreatic juice becomes thick and builds up -> blocks duct -> trypsinogen more likely to come into contact with lysosomal digestive enzymes, which convert it into trypsin -> now trypsin can activate other digestive enzymes and cause autodigestion of the pancreas
Also:
ROS
By increasing the release of digestive enzymes from the pancreas
Inflammation, recruiting neutrophils and releasing digestive enzymes

24
Q

What is the leading cause of death from acute pancreatitis?

A

ARDS

25
Q

Patients often say that being in what position slightly relieves the pain?

A

Sitting forward (tripod position) with feet up

26
Q

What makes the pain worse?

A

Aggravated by movement

Year 3 - Gastro (42 decks)

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