Week 11- Pancreatitis Flashcards
What is acute pancreatitis?
Rapid onset inflammation of the pancreas
What is chronic pancreatitis?
Long standing inflammation of the pancreas
What could cause acute pancreatitis and what acronym is used to remember the factors?
GETSMASHED Gallstones Ethanol Trauma Steroids Autoimmune Scorpion/snakebite Hypercalcaemia/hypertriglyceridemia/hypothermia ERCP Drugs
What drugs can cause acute pancreatitis and what acronym is used to remember them?
SAND Steroids Azothioprine NSAIDs Diuretics
Describe the pathogenesis of acute pancreatitis?
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
How are pancreatic enzymes activated intracellularly?
Proenzymes and lysosomal proteases are incorporated into small vesicles which activates trypsin
What are the 3 types of acute pancreatitis
Oedematous pancreatitis
Haemorrhagic pancreatitis
Necrotic pancreatitis
What are symptoms of acute pancreatitis?
Epigastric pain radiating to the back, often eased by sitting forward
Nausea and vomitting
Fever
What are signs of acute pancreatitis?
Heamodynamic instability
Peritonism in the upper abdomen
Grey/Turner’s sign (bruising around umbilicus)
Cullen’s sign (bruising around umbilicus)
What is Grey Turner’s sign?
Bruising in flanks
What is Cullen’s sign?
Bruising around umbillicus
What signs are specifically seen in haemorrhagic pancreatitis?
Grey Turner’s sign
Cullen’s sign
What are differential diagnoses for acute pancreatitis?
Gallstone disease
Peptic ulcer disease/perforation
Leaking/ruptured abdominal aortic aneurysm
What should you look at in a blood test when diagnosing acute pancreatitis?
Amylase/ lipase
What x rays may be ordered when acute pancreatitis is suspected?
Erect chest x ray
Abdominal x ray
When may a abdomen CT be ordered for acute pancreatitis?
When patients arent settling with conservative management and its only 48-72 hrs after symptom onset
What is used to assess acute pancreatitis severity and what acronym do we use?
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
How is CRP used to diagnose acute pancreatitis?
Independant predictor, >200 suggests severe pancreatitis
What are the 4 principles of management for acute pancreatitis?
Fluid resuscitation
Analgesia
Pancreatic rest
Determining underlying cause
What is the usual treatment plan for acute pancreatitis?
95% conservative treatment
Antibiotics and controversial, commence if necrotic pancreatitis/ infected necrosis but not routinely
What are some systemic complications of acute pancreatitis?
Hypocalcaemia
Hyperglycaemia
SIRS (systemic inflammatory response syndrome)
ARF (acute renal failure)
ARDS (adult respiratory distress syndrome)
DIC (disseminated intravascular coagulation)
MOF (multi organ failure)
What are some local complications of acute pancreatitis?
Pancreatic necrosis Pancreatic abcess Pancreatic pseudocyst Haemorrhage Thrombosis Chronic pancreatitis
How is infected necrosis treated?
With antibiotics and surgery (dead tissue needs to be debrided)
How does pancreatic abscess arise?
Its a complication of pancreatic necrosis
What is pancreatic abscess?
Collection of pus from pancreatic tissue necrosis and infection
When does pancreatic abscess present?
2-4 weeks after attack of pancreatitis
How is pancreatic abscess managed?
Antibiotics and drainage
What is a pancreatic pseudocyst
Peri pancreatic fluid collection within a fibrous capsule
When does pancreatic pseudocyst present?
More than 6 weeks after pancreatitis
How does pancreatic pseudocyst resolve?
95% spontaneously resolves unless there is pain, causes compression of surrounding structures, its infected where it is then drained
How is pancreatic pseudocyst managed?
Percutaneously- with CT
Endoscopically
Surgically- via laparoscopy/open
