Pancreatitis Flashcards
Define acute pancreatitis
An acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems
Which artery supplies the
Coeliac trunk
Superior mesenteric artery
Splenic artery
Where does the bile enter the duodenum?
Sphincter of odi
What is the name of the cell that produces enzymatic material in the pancreas?
Acinar cell
Aetiology
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
Which of these are the most common causes?
Gallstones (middle aged/female - due to high oestrogen levels)
Ethanol (male/young person)
Epidemiology
Peak age - 60years
V common
Symptoms
Severe epigastric pain, radiating to the
Anorexia
Nausea
Vomiting
Signs
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
What’s the amylase level like?
Very high serum amylase (does not correlate with severity)
Investigations
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)
Why is the calcium low?
Due to saponification, where the calcium binds to digested lipids from pancreas, forming a soap)
Why do you get high glucose?
Glucagon is released
When do you get deranged LFTs?
Gallstone pancreatitis or alcohol ?Obstructive jaundice
GGTs
ALP
Why do you do a CXR?
Pleural effusion
to check for bowel performation
Which score is used to assess pancreatitis severity?
Modified glasgow score, combined with a CRP level of above 210?
Name another score
APACHE-2 score
Medical management
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
What do you do to manage gallstone pancreatitis
ERCP and sphincterectomy
Surgery to manage
Local Complications
Pancreatic necrosis Abscess (e.coli infected) Pseudocyst (peripancreatitic fluid collection lasting more than four weeks) Ascites Pseudoaneurysm Venous thrombosis
Systemic complications
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
Prognosis
20% severe mortality
Infected necrosis - 70% mortality
How does alcohol cause pancreatitis?
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
What is the leading cause of death from acute pancreatitis?
ARDS
Patients often say that being in what position slightly relieves the pain?
Sitting forward (tripod position) with feet up
What makes the pain worse?
Aggravated by movement
