Pancreatitis Flashcards
Define Pancreatitis?
An acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems
How can Pancreatitis be classified?
Mild: minimal organ dysfunction and uneventful recovery
Severe: Organ failure and/or local complications such as necrosis, abscesses and pseudocysts
What is the aetiology of Pancreatitis?
An insult will result in the activation of pancreatic proenzymes within the pancreatic duct/acini leading to tissue damage and inflammation
What are the causes of Pancreatitis?
GET SMASHED Gallstones Ethanol Trauma Steroids Mumps/HIV/Coxsackie Autoimmune Scorpion venom Hypercalcaemia/Hypothermia ERCP Drugs
What are some examples of drugs that can cause Pancreatitis?
Sodium Valproate
Steroids
Thiazides
Azathioprine
What is the epidemiology of Pancreatitis?
Common
UK annual incidence: 10/10,000
Peak age: 60 yrs
What is the most common cause of Pancreatitis in males?
Alcohol
What is the most common cause of Pancreatitis in Females?
Gallstones
What are the presenting symptoms of Pancreatitis
Severe epigastric pain Radiating to the back Relieved by sitting forward Aggravated by movement Associated with anorexia, nausea and vomiting
What do we check for in a history for Pancreatitis?
Check whether the patient has a history of high alcohol intake or gallstones
What are the signs of Pancreatitis on physical examination?
Epigastric tenderness
Fever
Shock (includes tachycardia and tachypnoea)
Decreased bowel sounds (due to ileus)
What are the signs of Severe Pancreatitis?
Cullen’s Sign (periumbilical bruising)
Grey-Turner sign (flank bruising)
What bloods do we do for Pancreatitis?
Very High Serum Amylase (this doesn't correlate with severity) High WCC U&Es High glucose High CRP Low calium LFTs ABG
Why do we do U&Es for Pancreatitis?
To check for dehydration
Why is Calcium low for Pancreatitis?
Saponification
Calcium binds to digested lipids from the pancreas to form soap
Why do we do LFTs for Pancreatitis?
May be deranged if gallstone pancreatitis or alcohol
Why do we do an ABG for Pancreatitis?
For hypoxia or metabolic acidosis
Why do we do an US for Pancreatitis?
Check for evidence of gallstones in biliary trees
Why do we do an Erect CXR for Pancreatitis?
May be pleural effusion
Also to check for bowel perforation
Why do we do an AXR for Pancreatitis?
Exclude other causes of acute abdomen
When do we do a CT scan for Pancreatitis?
If diagnosis is uncertain or if persisting organ failure
What are the two ways we assess the severity of Pancreatitis?
Modified Glasgow Score (combined with CRP (> 210mg/L))
APACHE-II Score
What is the medical management plan for Pancreatitis?
Fluid and electrolyte resuscitation
Urinary catheter and NG tube if vomiting
Analgesia
Blood sugar control
HDU and ITU care
Prophylactic antibiotics may be useful in reducing mortality
Why do we do an ERCP and Sphincterotomy for Pancreatitis?
Used for gallstone Pancreatitis, cholangitis, jaundice or dilated common bile duct
Ideally performed within 72 hrs
All patients presenting with gallstone pancreatitis should undergo definitive management of gallstones during the same admission or within 2 weeks
What is the management plan with regards to early detection and treatment of complications of Pancreatitis?
For example if there are persistent symptoms or > 30% pancreatic necrosis or signs of sepsis leads to image guided fine needle aspiration for culture
What is the surgical management plan of Pancreatitis?
Necrotising Pancreatitis should be managed by specialists
Necresectomy (drainage and debridement of necrotic tissue) may be necessary
What are the Local complications of Pancreatitis?
Pancreatic Necrosis Pseudocyst (peripancreatic fluid collection lasting > 4 weeks) Abscess Ascites Pseudoaneurysm Venous thrombosis
What are the systemic complications of Pancreatitis?
Multiorgan dysfunction Sepsis Renal Failure ARDS DIC Hypocalcaemia Diabetes
What are the long-term complications of Pancreatitis?
Could result in Chronic Pancreatitis
What is the prognosis for Pancreatitis?
20% follow severe fulminating course with high mortality
Infected pancreatic necrosis has a 70% mortality
80% follow a milder course (but this still has 5% mortality)
