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HPB > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

Sudden onset inflammation of the pancreas and loss of function which resolves

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2
Q

What are the different patterns of lobule injury?

A

Periductal necrosis
Panlobular necrosis
Perilobular necrosis

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3
Q

Describe periductal necrosis

A

Necrosis of acinal cells adjacent to ducts

Due to duct obstruction

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4
Q

Describe panlobular necrosis

A

Necrosis of whole acinar lobule
Generally due to drugs/toxins/viruses/metabolic insults
Spread from periductal necrosis

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5
Q

Describe perilobular necrosis

A

Necrosis of the peripheries of lobules

Due to poor vascular perfusion

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6
Q

What are the potential early complications of pancreatitis?

A 
Shock
ARDS
Renal failure
DIC
Hypocalcaemia
Hyperglycaemia
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7
Q

What are the causes of acute pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion Bite
Hyperlipidaemia, hypercalcaemia and hypothermia
ERCP
Drugs- azathioprine, diuretics, sodium valproate
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8
Q

What is the pathology underlying pancreatitis?

A

Original insult leads to activation of pancreatic enzymes within pancreatic cells leading to destruction and necrosis of pancreas causing inflammation

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9
Q

What are the Sx of acute pancreatitis?

A

Epigastric pain radiating to the back
Worse on lying down and relieved by sitting forwards

N&V

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10
Q

What are the signs of acute pancreatitis?

A 
Tachycardia
Fever
Ileus
Jaundice 
Rigid abdomen
Cullen's sign
Grey-Turner's sign
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11
Q

What is Cullen’s sign?

A

Periumbilical discolouration due to haemmorhage into peritoneal space

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12
Q

What is Grey-Turner’s sign?

A

Discolouration in flanks

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13
Q

What blood tests are appropriate when investigating suspected acute pancreatitis?

A 
FBC
U&Es
LFTs
CRP
Amylase
Lipase
Ca
Bilirubin
ABG- for early resp failure
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14
Q

What imaging is appropriate when investigating suspected acute pancreatitis?

A

USS- look for gallstones
CT abdo for complications
CXR for perforation
ERCP- if concerned of obstruction to insert stent

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15
Q

What scoring systems can be used to predict the prognosis for acute pancreatitis?

A

Modified Glasgow Criteria
APACHE II
Ranson criteria

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16
Q

Describe the Modified Glasgow Criteria

A
  • PaO2 <8kPa
  • Age >55
  • Neutrophils (WBC >15*10^9/L)
  • Calcium <2mmol/L
  • Renal urea >16mmol/L
  • Enzymes (LDH >600iu/L, AST >200iu/L)
  • Albumin <32g/L
  • Sugar (glucose >10mmol/L)
17
Q

Describe APACHE II

A

Allocates points for assessment of clinical parameters (A), age (B) and co-morbidities (C)
>9 indicates severe pancreatitis

18
Q

Describe the Ranson criteria

A

Includes age + lab scores on admission + clinical findings at 48 hrs to give mortality risk

19
Q

What are the potential late complications of acute pancreatitis?

A 
Pancreatic pseudocyst
Abscesses
Bleeding (elastase eroding major vessel)
Fistulae
Thrombosis of splenic/gastroduodenal aa (bowel necrosis)
Chronic pancreatitis
20
Q

What is the immediate management of acute pancreatitis?

A 
A-E resus
IV fluid
Catheterise
Hrly monitoring - BP, pulse, urine output
Daily bloods - FBC, U&Es, Ca, glucose, ABG
Analgesia
NBM- enteral nutrition only if indicated e.g. patient vomiting
Stop alcohol
Treat gallstones 
NG tube suction (if ileus/emesis)
PPI (prevent stress ulcer)
Anticoagulation
Consider ITU admission
Abx if infection
21
Q

What additional management steps may be needed to treat the early complications of acute pancreatitis?

A 
Antibiotics (severe cases)
Laparotomy/debridement (abscess/pancreatic necrosis)
Urgent ERCP (gallstones)
22
Q

What is the prognosis of acute pancreatitis?

A

Unpredictable condition

  • 85% settle w/i 3-7 days
  • 15% require ICU admission (50% of these die)
23
Q

What are the potential metabolic complications of acute pancreatitis?

A

Hyperglycaemia
Hypocalcaemia
Reduced serum albumin
Malabsorption (reduced vit levels)

24
Q

How does the glasgow score determine severity of acute pancreatitis?

A

0-1 mild
2 moderate
>3 severe

25
Q

What is chronic pancreatitis?

A

Where inflammation continues causing permanent damage to pancreas

26
Q

What are the symptoms of chronic pancreatitis?

A

Chronic epigastric pain
Loss of endocrine and exocrine function
Increased incidence of pseudocysts and abscesses

27
Q

What is the management of chronic pancreatitis?

A

CT scan with IV contrast to confirm diagnosis
Stop alcohol and smoking
Regular analgesia
Replacement of exocrine enzymes e.g. Creon
SC insulin
Surgery to treat abscesses
ERCP for stenting

HPB (7 decks)

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