Severe Upper Abdo Pain Flashcards
What causes abdominal pain and hypotension?
Acute Pancreatitis
Perforated peptic ulcer
Ruptured AAA
Ectopic pregnancy
How is the diagnosis of pancreatitis made?
2/3 of the following:
Abdominal pain
3x normal lipase
CT findings of pancreatitis
What are the most sensitive enzymes for gall stones in the setting of pancreatitis?
ALT and AST
How do gall stones cause pancreatitis?
Stone in the common bile duct - not fully understood
- either blockage of pancreatic duct or reflux of duodenal fluid
- end point is stasis of trypsinogen in the pancrease which is activated into trypsin
Outline how pancreatitis is characterised?
Mild - no organ failure
Moderate - Limited organ failure
Severe - Multi organ failure
What is a useful test to assess pancreatitis severity?
CRP at 48 hours - >150 is severe
What is the best scoring system for pancreatitis severity in our patient population?
Modified Glasgow
What did the SAFE trial show?
That albumin and saline are equivalent for resuscitation
What is the normal urine output?
0.5-1ml/kg/hour
What are some acute complications of acute pancreatitis?
SIRS = Hypoxia or Renal failure/impairment
Cholangitis
Necrotising pancreatitis
Hospital acquired infection secondary to atelectasis
L Colon infarction
Walled off necrosis
When should an ERCP be performed in pancreatitis?
If cholangitis develops
What are the hallmarks of SIRS?
Temperature -
RR - >20
Tachycardia - >
WBC -
What is MODS?
Multiple organ dysfunction syndrome
What blood markers can be used to differentiate sepsis from SIRS
Pro-calcitonin
What is a simple formula for PaO2 on oxygen supplementation?
FiO2 x 5
What does CPAP and BIPAP stand for? When are they indicated?
Continuous positive airways pressure
Bi-level positive airways pressure - adds some inspiratory pressure to help ventilate
To help ventilation (not gas exchange)
When are IV abx indicated in pancreatitis? Which abx is used?
Cholangitis
Infected necrotising pancreatitis
Meropenem
When (time wish) does infected pancreatitis occur?
1-3 weeks later
What type of feeding replacement is best in pancreatitis?
NG
What is the most common yeast and mould?
Yeast - Candida
Mould - Aspergillus
What are some risk factors for yeast infections?
Immunosuppression
Intra-abdominal surgery
Lines
TPN
Malnutrition
Blood transfusions
Pancreatitis + biliary colic = ???
Cholecystectomy
