Acute pancreatitis Flashcards
What are the events leading to pancreatitis?
intrapancreatic activation of pancreatic enzymes -> destruction of pancreatic parenchyma -> attraction of inflammatory cells -> pancreatitis
What are the consequences of pancreatitis?
- capillary leakage, hypotension, tachycardia -> DISTRIBUTIVE SHOCK
- pancreatic necrosis
- hypocalcemia -> lipase breaks down peripancreatic & mesenteric fat -> FATTY SAPONIFICATION
- hemorrhage
What are the causes of pancreatitis?
- gallstones
- alcohol
- post-ERCP
- idiopathic
- drugs
- hypercalcaemia
- pancreas divisum
What are the systemic complications of pancreatitis?
- ileus
- visual disturbances
- confusion
- irritability
- encephalopathy
What are the metabolic complications of pancreatitis?
- hypocalcemia
- hyperglycemia
- hyperlipidemia
What is the clinical presentation of a pancreatitis patient?
- acute severe constant refractory EPIGASTRIC PAIN
- radiates TO BACK
- relieved by sitting or leaning forward
- nausea
- vomiting
- retching
What will be seen upon physical examination of acute pancreatitis patient?
- ill patient in severe pain
- +- jaundice
- normothermia -> if fever -> acute cholangitis
- signs of shock -> tachycardia, tachypnea, hypotension
- abdominal tenderness at epigastrium +- diffuse abdominal pain
- guarding +- rigidity
- Cullen’s sign
- Grey Turner’s sign
- Fox’s sign
What labs should be obtained to confirm acute pancreatitis?
- Serum lipase +- amylase
- CBC
- CRP -> bad prognostic sign
- electrolytes -> hypokalemic hypochloridemic metabolic alkalosis
What is Ranson’s Criteria for acute pancreatitis?
AT ADMISSION
- > 55 years
- WBC > 16000
- glucose > 11mmol OR > 200mg
- serum AST > 250
- serum LDH > 350
AT 48 HOURS
- serum calcium <2mmol OR <8mg
- hematocrit fall > 10%
- hypoxemia PaO2 < 60 mmg
- BUN increased by 1.8mmol or more (5mg or more) after IV hydration
- sequestration of fluids > 6L
- if > or = 3: severe pancreatitis likely
- if < 3: severe pancreatitis unlikely
What imaging techniques are used to diagnose acute pancreatitis?
ABDOMINAL US
- pancreatic edema & swelling
- gallstones
- cholecystitis
- dilated CBD
X ray
- sentinel loop
- colon cut-off
CT -> at 48-72 hours
What are the grades of pancreatitis according to Balthazar score?
A -> normal: 0
B -> enlarged: 1
C -> inflammatory changes in pancreas & peripancreatic fat: 2
D -> ill-defined single peripancreatic fluid collection: 3
E -> 2 or more poorly defined peripancreatic fluid collections: 4
A-C -> early
B & E -> severe
What investigations should be done for every pancreatitis case?
MRCP
ERCP
EUS -> in case of ampulla of Vater tumor
How is mild pancreatitis managed?
- admission
- analgesics
- IV fluids
- NPO
- VTE prophylaxis
- treat cause -> if gallstones -> cholecystectomy in same admission
- continuous monitoring
How is severe pancreatitis managed?
- IV RESUSCITATION
- ICU admission
- prophylactic antibiotic
- VTE prophylaxis -> MAY cause hemorrhage
- Foley’s catheter
- intra abdominal pressure monitoring to prevent compartment syndrome
- CVP
- NGT if vomiting
- NPO
What are the complications of acute pancreatitis?
- acute peripancreatic fluid collection (APFC) -> resolves spontaneously (drainage only if symptomatic)
- pseudocyst
- pancreatic necrosis
- pancreatic ascites
- pancreatic pleural effusion -> drain
- hemorrhage
- portal or splenic vein thrombosis
