Pancreatitis Flashcards
GETSMASHED acronym
G - gallstones
E - ethanol
T - trauma
S - steroids
M - mumps and other viruses (EBV, CMV)
A - autoimmune (polyarteritis nodosa, SLE)
S - scorpion/snake bite
H - hypercalcaemia, hypertriglyceridaemia, hypothermia
E - ERCP (endoscopic retrograde cholangiopancreatography)
D- drugs (SAND: steroids and sulphonamides, azothioprine, NSAIDS, diuretics)
What is the pathogenesis of acute pancreatitis
Increased permeability of the pancreatic duct eptihelium (alcohol, acetylsalicylic acid, histamine) - enzymes diffuse into periductal interstitial tissue
Alcohol can precipitate and form protein plugs
Pancreatic enzymes cna be activated intracellularly (proenzymes and lysomal proteases incorporated into same vesicles - trypsin activated
What are the differetn types of acute pancreatitis
Oedematous pancreatitis
Haemorrhagic pancreatitis
Necrotic pancreatitis - infected necrosis
Clincal features of acute pancreatitis
Epigastric pain radiating to back alleviated by sitting forward
Nausea and vomiting
Fevers -
Haemodynamic instability (tachycardic, hypotensive)
Peritonism in upper abdomen and generalised
Bruising in flanks - grey-turner’s sign
Brusiing around umbilibus - cullen’s sign
Differential diagnoses of acute pancreatitis
Gallstone disease and associated complications (biliary colic and acute cholecystitis)
Peptic ucler
Leaking/reuptured AAAA
Investigations for acute pancreatitis
Blood test - amlyse (due to renal failure, macroamylasaemia, bowel perforation, malignancies, parotitis)
X rays - erect chest x rays
abdominal x ray
uss - look fort gallstones
CT abdomen - if patients arent settling
MRCP - GS suspected with abnormal LFT
ERCP - remove CBD GS
How to suggest severity of pancreatitis
How to manage acute pancreatitis
ABC
Principles - fluid resuscitation (IV, urine catheter, fluid balance monitoring), analgesia, pancreatic rest (nasojejunal feeding or total parenteral nutrition), determining underlying cause
95% conservative treatment
Severe - HDU
Antibiotics only if necrotic pancreatitis
Surgery rarely required
Acut Pancreatitis complications
Hypocalcaemia - lipase - FFA - chelate Ca salts - decreased serum levels (saponification)
Hyperglycaemia
SIRS (Systemic inflammatory response syndrome)
ARF (Acute renal failure)
ARDS (Adult respiratory distress syndrome_
DIC (Disseminated Intravascular Coagulation)
MDF and death
Complications of acute pancreatitis
Pancreatic necrosis
Pancreatic abscess - collection of pus, tissue necrosis and infection
Pancreatic pseudocyst
Haemorrhage - bleeding from arroded vessels
Thrombosis of splenic vein, SMV, portal vein which leads to ascites and ischaemia
What happens if there is infected necrosis
What happens during a pancreatic pseudocyst
Pseudocyst - increase peri-pancreatic fluid collection, increase pancreatic enzymes within a gibrou capsule and no epithelium lining
Normally present >6 weeks
95% spontaneously resolve
Intervention if - pseudocyst symptomatic, pseudocyst causing comrpression leading to CBD
How do you manage the pseudocyst
Percutaneously under radiological guidance
Endoscopically - punctur posterior wall of stomach and insert stent
Surgically - pseudocystgastrostomy, pseudocystjejunostomy
What are the many symptoms of chronic pancreatitis
Destroys endocrine and exocrine tissue
you get insulin dependent diabetes mellitus and steatorrheoa
What are the causes of chronic pancreatitis
What is the management of chronic pancreatitis
Don;t do anything unelss they have pain
ERCP - grab stone - lithotripsy - mechanical - you can put a stent in
Surgical drainage - core out head of pancreas, remove as many stones as possible take a loop of small bowel and join onto pancreas
Final port of call distal pancreatomy, proximal pancreatomy, full pancreatomy
