Pancreatitis Flashcards
What do pancreatic acinar cells surround?
Intercellular canaliculi
What is acute pancreatitis?
Rapid onset of inflammation of the pancreas
What is chronic pancreatitis?
Long-standing inflammation of the pancreas- results in pancreatic stones made of calcium within ducts
What are causes of acute pancreatitis?
G-gallstones E-ethanol T-trauma S-steroids M-mumps and other viruses (EBV,CMV) A-autoimmune S-scorpion/ snake bite H- hypercalcemia, hypertriglyceridemia, hypothermia E- ERCP D- drugs (SAND- steroids and sulphonamides, azathioprine, NSAIDS, diuretics)
What is the pathogenesis of acute pancreatitis?
Increased permeability of pancreatic duct epithelium (commonest cause: alcohol, acetylsalicylic acid, histamine)- acinar cell enzymes diffuse into periductal interstitial tissue
Alcohol precipitate proteins in ducts- increase in upstream pressure
Pancreatic enzymes activated intracellularly- proenzymes and lysosomal proteases incorporated into same vesicles- trypsin activated
What are 3 different acute pancreatitis?
Oedematous pancreatitis- peripancreatic fluid
Hemorrhagic pancreatitis- bleeding of pancreas
Necrotic pancreatitis- infected necrosis
What are symptoms of acute pancreatitis?
Epigastric pain radiating to back- better when sitting up
Nausea and vomiting
Fevers
What are signs of acute pancreatitis?
Haemodynamic instability (tachycardic, hypotensive)
Peritonism: in upper abdomen/ generalised
Grey- Turner’s sign (bruising in flanks)
Cullen’s sign (bruising around umbilicus)
Grey- Turner’s and cullen’s sign seen in hemorrhagic pancreatitis)
What are differential diagnoses to acute pancreatitis?
Might be…
Gallstone disease and associated complications (biliary colic and acute cholecystitis)
Peptic ulcer disease/perforation
Leaking/ ruptured aortic aneurysm
What investigations would be carried out for acute pancreatitis?
Blood tests: amylase/lipase
X-rays: Erect CXR, AXR
US: look for gallstones
CT abdomen- for patients not settling with conservative management and only after 48-72 hours of symptom onset
MRCP: If GS pancreatitis is suspected with an abnormal liver function test
ERCP: to remove common bowel duct GS
What is the criteria to assess the severity of acute pancreatitis?
P- PO2 <8KPa A- age >55 yrs N- WCC > 15 C- calcium <2mmol/L R- renal >16mmol/L E- enzymes: AT>200iu/L, LHD>600iu/L A- Albumin (32g/L S- Sugar >10mmol/L
Score of 3 or more within 48hrs of onset suggests severe pancreatitis
C reactive protein is an independent predictor of severity:
>200 suggests severe pancreatitis
How do you manage acute pancreatitis?
ABC’s
Fluid resuscitation- IV fluids, urinary catheter, strict fluid balance monitoring
Analgesia
Pancreatic rest and +/- nutritional support if prolonged recovery
Determine underlying cause
95% settle with conservative treatment
If severe pancreatitis on scoring- high dependency unit
Antibiotics are controversial- commence if necrotic pancreatitis but not routinely
Surgery very rarely required
What are systemic complications of acute pancreatitis?
Hypocalcaemia: lipase- FFAs- chelate Ca2+ salts- decrease serum levels (saponification)
Hyperglycemia- diabetes if significant beta cell damage
SIRS- systemic inflammatory response syndrome
ARD- acute renal failure
ARDS- Adult respiratory distress syndrome
DIC- disseminated intravascular coagulation
MOF- multi-organ failure and death
What are local complications of acute pancreatitis?
Pancreatic necrosis
Pancreatic abscess
Pancreatic pseudocyst
Haemorrhage: due to bleeding from arroded vessels:
-small vessels is hemorrhagic pancreatitis
-large vessels are splenic artery
Thrombosis of splenic vein, superior mesenteric vein, portal vein:
-ascites- fluid in abdomen
-small bowel venous congestion/ischaemia
Chronic pancreatitis
What is management for infected necrosis?
Antibiotics and percutaneous drainage
Surgery potentially (only pancreatitis surgery is used for):
-high mortality if infected tissue is not debrided
-surgery involves necrosectomy
