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BRS Y1 > Week 11- Pancreatitis > Flashcards

Week 11- Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

Rapid onset inflammation of the pancreas

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2
Q

What is chronic pancreatitis?

A

Long standing inflammation of the pancreas

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3
Q

What could cause acute pancreatitis and what acronym is used to remember the factors?

A 
GETSMASHED
Gallstones
Ethanol
Trauma
Steroids
Autoimmune
Scorpion/snakebite
Hypercalcaemia/hypertriglyceridemia/hypothermia
ERCP
Drugs
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4
Q

What drugs can cause acute pancreatitis and what acronym is used to remember them?

A 
SAND
Steroids
Azothioprine
NSAIDs
Diuretics
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5
Q

Describe the pathogenesis of acute pancreatitis?

A

Increased permeability of the pancreatic duct epithelium so acinar enzymes diffuse into the interstitial tissue

Alcohol proteins in ducts increase upstream pressure

Pancreatic enzymes are activated intracellularly

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6
Q

How are pancreatic enzymes activated intracellularly?

A

Proenzymes and lysosomal proteases are incorporated into small vesicles which activates trypsin

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7
Q

What are the 3 types of acute pancreatitis

A

Oedematous pancreatitis
Haemorrhagic pancreatitis
Necrotic pancreatitis

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8
Q

What are symptoms of acute pancreatitis?

A

Epigastric pain radiating to the back, often eased by sitting forward
Nausea and vomitting
Fever

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9
Q

What are signs of acute pancreatitis?

A

Heamodynamic instability
Peritonism in the upper abdomen
Grey/Turner’s sign (bruising around umbilicus)
Cullen’s sign (bruising around umbilicus)

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10
Q

What is Grey Turner’s sign?

A

Bruising in flanks

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11
Q

What is Cullen’s sign?

A

Bruising around umbillicus

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12
Q

What signs are specifically seen in haemorrhagic pancreatitis?

A

Grey Turner’s sign

Cullen’s sign

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13
Q

What are differential diagnoses for acute pancreatitis?

A

Gallstone disease
Peptic ulcer disease/perforation
Leaking/ruptured abdominal aortic aneurysm

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14
Q

What should you look at in a blood test when diagnosing acute pancreatitis?

A

Amylase/ lipase

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15
Q

What x rays may be ordered when acute pancreatitis is suspected?

A

Erect chest x ray

Abdominal x ray

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16
Q

When may a abdomen CT be ordered for acute pancreatitis?

A

When patients arent settling with conservative management and its only 48-72 hrs after symptom onset

17
Q

What is used to assess acute pancreatitis severity and what acronym do we use?

A 
Modified glasgow criteria- PANCREAS
Po2 <8kPa
Age >55yrs
N- WCC >15
Calcium <2mmol/L
Renal: urea >16mmol/L
Enzymes: AST >200iu/L, LDH >600iu/L
Albumin <32 g
Sugar >10mmol/L
Score of > 3 suggests severe pancreatitis
18
Q

How is CRP used to diagnose acute pancreatitis?

A

Independant predictor, >200 suggests severe pancreatitis

19
Q

What are the 4 principles of management for acute pancreatitis?

A

Fluid resuscitation
Analgesia
Pancreatic rest
Determining underlying cause

20
Q

What is the usual treatment plan for acute pancreatitis?

A

95% conservative treatment

Antibiotics and controversial, commence if necrotic pancreatitis/ infected necrosis but not routinely

21
Q

What are some systemic complications of acute pancreatitis?

A

Hypocalcaemia
Hyperglycaemia
SIRS (systemic inflammatory response syndrome)
ARF (acute renal failure)
ARDS (adult respiratory distress syndrome)
DIC (disseminated intravascular coagulation)
MOF (multi organ failure)

22
Q

What are some local complications of acute pancreatitis?

A 
Pancreatic necrosis
Pancreatic abcess
Pancreatic pseudocyst
Haemorrhage
Thrombosis
Chronic pancreatitis
23
Q

How is infected necrosis treated?

A

With antibiotics and surgery (dead tissue needs to be debrided)

24
Q

How does pancreatic abscess arise?

A

Its a complication of pancreatic necrosis

25
Q

What is pancreatic abscess?

A

Collection of pus from pancreatic tissue necrosis and infection

26
Q

When does pancreatic abscess present?

A

2-4 weeks after attack of pancreatitis

27
Q

How is pancreatic abscess managed?

A

Antibiotics and drainage

28
Q

What is a pancreatic pseudocyst

A

Peri pancreatic fluid collection within a fibrous capsule

29
Q

When does pancreatic pseudocyst present?

A

More than 6 weeks after pancreatitis

30
Q

How does pancreatic pseudocyst resolve?

A

95% spontaneously resolves unless there is pain, causes compression of surrounding structures, its infected where it is then drained

31
Q

How is pancreatic pseudocyst managed?

A

Percutaneously- with CT
Endoscopically
Surgically- via laparoscopy/open

BRS Y1 (52 decks)

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