Pancreatitis (Acute) Flashcards
def
acute inflammation of the pancreas
1 mild
-minimal organ dysfunction + recovery
2 severe
-organ failure +/ complications (necrosis)
aetiology
insult to pancreas causes activation of pancreatic proenzymes resulting in tissue damage + inflammation
where does activation of pancreatic proenzymes occur
duct/acini
common causes of acute pancreatitis
1 gallstones 2 alcohol --80% of cases-- 3 drugs 4 trauma 5 ERCP/abdominal surgery 6 infection
what drugs can cause acute pancreatitis
steroids
azathioprine
thiazides
valproate
what infections can cause acute pancreatitis
mumps
EBV
CMV
coxsackie B
what is the mnemonic for causes of pancreatitis
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpian venom Hyperlipidaemia, hypothermia, hypercalcaemia ERCP + emboli Drugs
epi
common
1/1000 PA in UK
60yrs
what is the most common cause of pancreatitis in females
gallstones
what is the most common cause of pancreatitis in males
alcohol
history
1 severe epigastric/abdominal pain
2 nausea + vomiting
3 history of gallstones/excess alcohol
what is the pain like in acute pancreatitis
severe epigastric/abdominal pain
radiates to back
relieved by sitting forward
aggravated by movement
examination
1 tachycardia
2 jaundice
3 epigastric tenderness + guarding
4 reduced bowel sounds due to ileus
what signs of bruising are indicative of pancreatitis
1 grey-turners sign
-flank bruising
2 cullens sign
-periumbilical bruising
why do grey-turners sign and cullens sign occur
blood vessel autodigestion from pancreatic enzymes + retroperitoneal haemorrhage
investigations
1 bloods -very high amylase -high glucose 2 ABG -for hypoxia + metabolic acidosis 3 USS -for gallstones 4 erect CXR/ AXR -exclude other causes (perforation) -if no psoas shadow indicates increased retroperitoneal fluid
what imaging is used to assess the severity and involvement of complications
CT/MRI
what level of serum amylase would you expect in acute pancreatitis
> 1000u/ml
or
3 times the upper limit of normal
why is amylase raised in acute pancreatitis
when the pancrease becomes inflamed it releases amylase into the blood
what does amylase do
breaks down starch
what marker is most specific for pancreatitis
lipase
breaks down fat
when do amylase levels start to fall
24-48h after onset
therefore amylase may be normal is severe pancreatitis
how is pancreatitis severity assessed
1 modified glasgow criteria (within 48h)
2 Ransons criteria (for alcoholic pancreatitis after 48h)
what is the modified glasgow criteria
assesses severity of pancreatitis
for gallstones +alcoholic pancreatitis
PaO2 <8kPa Age >55yrs Neutrophilia WBC>15x10^8 Calcium <2mmol/l Renal function urea >16mmol/l Enzymes LDH>600, AST >200 Albumin <32g/l (serum) Sugar BG>10mmol/l
management
1 medical -nil by mouth (NG tube) -IV fluids + electrolytes -catheterisation -analgesia (morphine) -blood sugar control 2 ERCP -gallstone removal with jaundice 3 surgical -patients with necrotising pancreatitis undergo necresectomy
why is a patient with acute pancreatitis nil by mouth and fed via a NG tube
to reduce pancreatic stimulation
complications
1 local -pancreatic necrosis -pseudocyst (peripancreatic fluid) -venous thrombosis which can lead to bowel necrosis 2 systemic -multiorgan dysfunction -sepsis -renal failure 3 long term -chronic pancreatitis
prognosis
20% severe pancreatitis
-infected pancreatic necrosis has 70% mortality
80% mild pancreatitis
-still 5% mortality
