Pancreatitis Flashcards
What are the causes of acute pancreatitis?
Causes can be remembered with the mnemonic GET SMASHED:
Gallstones (most common worldwide)
Ethanol (most common cause in Europe)
Trauma
Steroids
Mumps
Autoimmune disease (Polyarteritis Nodosa/SLE)
Scorpion bite (!)
Hypercalcaemia, hypertriglycerideaemia, hypothermia
ERCP
Drugs (as above)
What are the drugs that can cause drug-induced acute pancreatitis?
A good mnemonic for drug-induced pancreatitis is FATSHEEP:
Furosemide Azathioprine/Asparaginase Thiazides/Tetracycline Statins/Sulfonamides/Sodium Valproate Hydrochlorothiazide Estrogens Ethanol Protease inhibitors and NRTIs
What are the symptoms of acute pancreatitis?
Acute pancreatitis is associated with a stabbing-like, epigastric pain which radiates to the back that is relieved by sitting forward or lying in the fetal position.
Acute pancreatitis is associated with a stabbing-like, epigastric pain which radiates to the back that is relieved by sitting forward or lying in the fetal position.
Importantly, past medical history and social history is vital. A recent alcoholic binge or a history of gallstones are highly suggestive.
What are the signs of acute pancreatitis?
Signs of hypovolaemia: tachycardia, dry mucous membranes
Potential fever
Guarding in epigastric area
What investigations would you do for suspected pancreatitis?
Bloods US abdomen (gallstones)
What parameter is highly suggestive of pancreatitis?
Amylase
How would you classify severity of pancreatitis?
Glasgow scale
It can be remembered by the mnemonic PANCREAS:
PaO2 < 8kPa (60mmHg) Age > 55 years Neutrophils - WBC >15 x109/l Calcium < 2mmol/l Renal function - Urea > 16mmol/l Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L Albumin < 32g/l Sugar - Glucose >10mmol/L
How would you manage acute pancreatitis?
The management of pancreatitis is to help maintain electrolyte imbalances and compensate for the third space losses seen in this disease. Supportive care is the main way of facilitating this:
- Aggressive fluid resuscitation with crystalloids
- Catherisation
- Analgesia
- anti-emetics
- IV antibiotics
What is chronic pancreatitis?
Chronic pancreatitis is caused by chronic inflammation and fibrosis of both the exocrine and endocrine components of the pancreas.
What are the main causes of chronic pancreatitis?
The most common cause is chronic alcohol excess (80% of patients).
Less common causes include genetic causes (such as cystic fibrosis), obstructive causes (such as pancreatic cancer), and metabolic causes (such as raised triacylglycerides).
What are the clinical features of chronic pancreatitis?
Patients present with epigastric pain, classically worse after eating fatty food and relieved by sitting forward.
There may be features of exocrine dysfunction, such as malabsorption and steatorrhoea.
On physical examination there may be epigastric tenderness. It is important to check for signs of chronic liver disease (suggestive of alcohol as a cause).
What sets chronic pancreatitis apart from acute pancreatitis?
Note that serum amylase and lipase are not typically raised in chronic pancreatitis
What investigations can you do for chronic pancreatitis?
Abdominal x-ray - calcifications
CT scan to show pancreatic calcification
How would you manage chronic pancreatitis?
Conservative measures such as ethanol abstinence and good diet.
Medical measures such as pain control with analgesia, management of endocrine dysfunction with insulin, and management of exocrine dysfunction with pancreatic enzyme replacement.
What are the complications that can follow chronic pancreatitis?
Complications may be local (such as pseudocyst or pancreatic cancer) and systemic (endocrine dysfunction i.e. diabetes mellitus, or exocrine dysfunction i.e. malabsorption and steatorrhoea).
