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gastrointestinal > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Define 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

How can Pancreatitis be classified?

A

Mild: minimal organ dysfunction and uneventful recovery
Severe: Organ failure and/or local complications such as necrosis, abscesses and pseudocysts

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3
Q

What is the aetiology of Pancreatitis?

A

An insult will result in the activation of pancreatic proenzymes within the pancreatic duct/acini leading to tissue damage and inflammation

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4
Q

What are the causes of Pancreatitis?

A 
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids 
Mumps/HIV/Coxsackie
Autoimmune 
Scorpion venom
Hypercalcaemia/Hypothermia
ERCP
Drugs
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5
Q

What are some examples of drugs that can cause Pancreatitis?

A

Sodium Valproate
Steroids
Thiazides
Azathioprine

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6
Q

What is the epidemiology of Pancreatitis?

A

Common
UK annual incidence: 10/10,000
Peak age: 60 yrs

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7
Q

What is the most common cause of Pancreatitis in males?

A

Alcohol

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8
Q

What is the most common cause of Pancreatitis in Females?

A

Gallstones

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9
Q

What are the presenting symptoms of Pancreatitis

A 
Severe epigastric pain 
Radiating to the back
Relieved by sitting forward 
Aggravated by movement 
Associated with anorexia, nausea and vomiting
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10
Q

What do we check for in a history for Pancreatitis?

A

Check whether the patient has a history of high alcohol intake or gallstones

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11
Q

What are the signs of Pancreatitis on physical examination?

A

Epigastric tenderness
Fever
Shock (includes tachycardia and tachypnoea)
Decreased bowel sounds (due to ileus)

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12
Q

What are the signs of Severe Pancreatitis?

A

Cullen’s Sign (periumbilical bruising)

Grey-Turner sign (flank bruising)

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13
Q

What bloods do we do for Pancreatitis?

A 
Very High Serum Amylase (this doesn't correlate with severity)
High WCC
U&Es 
High glucose 
High CRP
Low calium 
LFTs
ABG
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14
Q

Why do we do U&Es for Pancreatitis?

A

To check for dehydration

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15
Q

Why is Calcium low for Pancreatitis?

A

Saponification

Calcium binds to digested lipids from the pancreas to form soap

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16
Q

Why do we do LFTs for Pancreatitis?

A

May be deranged if gallstone pancreatitis or alcohol

17
Q

Why do we do an ABG for Pancreatitis?

A

For hypoxia or metabolic acidosis

18
Q

Why do we do an US for Pancreatitis?

A

Check for evidence of gallstones in biliary trees

19
Q

Why do we do an Erect CXR for Pancreatitis?

A

May be pleural effusion

Also to check for bowel perforation

20
Q

Why do we do an AXR for Pancreatitis?

A

Exclude other causes of acute abdomen

21
Q

When do we do a CT scan for Pancreatitis?

A

If diagnosis is uncertain or if persisting organ failure

22
Q

What are the two ways we assess the severity of Pancreatitis?

A

Modified Glasgow Score (combined with CRP (> 210mg/L))

APACHE-II Score

23
Q

What is the medical management plan for Pancreatitis?

A

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

24
Q

Why do we do an ERCP and Sphincterotomy for Pancreatitis?

A

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

25
Q

What is the management plan with regards to early detection and treatment of complications of Pancreatitis?

A

For example if there are persistent symptoms or > 30% pancreatic necrosis or signs of sepsis leads to image guided fine needle aspiration for culture

26
Q

What is the surgical management plan of Pancreatitis?

A

Necrotising Pancreatitis should be managed by specialists

Necresectomy (drainage and debridement of necrotic tissue) may be necessary

27
Q

What are the Local complications of Pancreatitis?

A 
Pancreatic Necrosis 
Pseudocyst (peripancreatic fluid collection lasting > 4 weeks)
Abscess
Ascites 
Pseudoaneurysm
Venous thrombosis
28
Q

What are the systemic complications of Pancreatitis?

A 
Multiorgan dysfunction
Sepsis 
Renal Failure 
ARDS 
DIC 
Hypocalcaemia 
Diabetes
29
Q

What are the long-term complications of Pancreatitis?

A

Could result in Chronic Pancreatitis

30
Q

What is the prognosis for Pancreatitis?

A

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)

gastrointestinal (61 decks)

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