Pancreatitis - acute Flashcards
acute vs chronic definition
- Acute = limited damage to secretory function of pancreas
- No gross structural damage
Causes of acute pancreatitis
IGETSMASHED
* Idiopathic
* Gallstones
* Ethanol - binge
* Trauma
* Steroid use
* Mumps
* Autoimmune eg SLE, sjogrens
* Scorpion bite
* Hypercalcaemia
* ERCP
* Drugs - azathioprine, NSAIDs, diuretics
Pathophys acute pancreatitis
- Each of the causes creates a premature and exaggerated activation of digestive enzymes
- = pancreatic inflammatory response
- = increased vascular permeability and fluid shifts (third spacing)
Third spacing fluids –> hypovolaemic shock
What happens in pancreatitis after it’s initiation?
- Enzymes released into systemic circulation
- Autodigestion of fats = fat necrosis and of blood vessels (can cause retroperitoneal bleeding)
- Fat necrosis can release fatty acids, react with calcium to form chalky deposits in fat = hypocalcaemia
What is severe end stage pancreatitis?
Necrosis - partial or complete
Presentation of pancreatitis - acute
- Sudden
- Severe
- Epigastric pain - radiate to back
- N+V
Signs on exam of acute pancreatitis
- Cullens sign - bruising around umbilicus
- Grey Turners sign - bruising flanks
- Tetany from hypocalcaema?
- If gallstones cause, can be jaundiced too
From retroperitoneal bleeding
differential for acute pancreatitis
- AAA
- Renal calculi
- Chronic pancreatitis
- Aortic dissection
- PUD
Investigations for acute pancreatitis - bloods
- Serum amylase or lipase (diagnostic if 3x upper limit)
- LFTs - concurrent cholestatic elements
Imaging for acute pancreatitis
- Abdominal USS - if cause unknown, see if gallstones
- AXR - sentinal loop sign (dilated loop adjacent to pancreas due to local inflam
- CXR - pleural effusion or ARDs
- Contrast enhanced CT - if none of these find cause/inconclusive
BUT severity assessing CT scans should only be done 6-10 days after admi
Only used if persistent inflam/organ failure
What will contrast enhanced CT scan of pancreas show?
If done after 48hrs from initial presentation:
* Pancreatic oedema/swelling
* Non-enhancing areas suggestive of pancreatic necrosis
Management acute pancreatitis
- No cure
- Treat underlying cause eg ERCP if gallstones
Supportive management for acute pancreatitis
- IV fluid resuscitation
- NG tube - if vomitting profusely for drainage
- Cathterisation to monitor urine output and fluid balance chart
- Opioid analgesia
When are abx used for acute pancreatitis?
- If confirmed pancreatic necrosis
- Broad spec eg imipenem
How to manage severe acute pancreatitis?
- Need to be on HDU or ITU