Acute Pancreatitis Flashcards

1
Q

Aetiology of acute pancreatitis

A

Duct obstruction: gallstones, trauma, tumours
Metabolic/toxic: alcohol, drugs, hypercalcaemia, hyperlipidaemia
Poor blood supply : shock, hypothermia
Infection/inflammation: viruses e.g. mumps

Obstruction: Gallstone stuck distal to where the common bile duct and pancreatic ducts join → reflux of bile up the pancreatic duct → damage to acini and release of proenzymes → become activated
Alcohol → spasm/oedema of the sphincter of Oddi → formation of protein-rich pancreatic fluid → obstructs the pancreatic ducts
All other causes cause direct acinar injury

(Gallstones (50%)
Ethanol (33%)
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyper-calcaemia/-lipidaemia
ERCP
Drugs (thiazides))

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2
Q

Risk factors for pancreatitis

A

Middle aged women
Young to middle-aged men
Gallstones
Alcohol
Hypertriglyceridaemia
Causative drugs e.g. azathioprine, thiazide diuretics, furosemide, sulfonamides, tetracyclines, oestrogen
ERCP
Trauma
SLE, Sjrogen’s
Hypercalcaemia
Mumps

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3
Q

Symptoms of acute pancreatitis

A

Epigastric pain
- Relived sitting forward
- Radiates to the back
- Worse on movement
Nausea and vomiting
Symptoms of pleural effusion: SOB, dry cough, pain, tightness
Anorexia
Dyspnoea
Jaundice

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4
Q

Signs of acute pancreatitis on examination

A

Obs
- Fever
- Shock - tachycardia, tachypnoea
General
- Signs of hypovolaemia
- Ischaemic (Purtscher) retinopathy (rare)
Abdo
- Epigastric tenderness
- Reduced bowel sounds on auscultation
- Cullen’s signs - umbilical bruising
- Grey Turner’s sign - bruising in the flanks (posterior), late sign

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5
Q

Investigations for pancreatitis

A

Amylase: raised 3x UL
Lipase: more sensitive and specific
- Cross match, G&S
- CRP/ESR
Severity grading:
- FBC
- U&Es
- Bone profile
- ABG
- LDH
- Albumin
- Glucose

US abdomen: visualise for inflammation + assess for gallstones
CXR: ?pleural effusion, ARDS
CTAP: diagnosis
MRCP: ?gallstones

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6
Q

How is pancreatitis graded

A

Modified Glasgow Imrie score
(PANCREAS)
PaO2 <8
Age >55
Neutrophils (WCC>15)
Calcium <2
uRea >16
Enzymes LDH >600
Albumin
Sugar >10

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7
Q

Management for acute pancreatitis

A
  1. fluid resus 1 hourly → 2h → 4h → 6h
  2. analgesia + anti-emetic
  3. Supportive
    - sats low → oxygen
    - Vomiting → NG tube (Ryles)
    - nutritional support
  4. catheter for fluid monitoring
  5. Thromboprophylaxis

Hypocalcaemia - replacement
Infection - IV Abs
Gallstone - ERCP, sphincterectomy
Alcohol- thiamine, vit B
Necrotising: Abx, IR drain, necrosectomy

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8
Q

What is used to assess organ failure in pancreatitis

A

Marshall score
Mild = no organ failure
Moderate = organ failre <48h

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9
Q

Early complications of acute pancreatitis

A

Early mortality caused by SIRS/multi-organ failure
Malabsorption (lipases not produced)
Multiorgan dysfunction
Sepsis
Renal failure
ARDS
DIC

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10
Q

Late complications of acute pancreatitis

A

Local:
- Peripancreatic fluid collections (most common)
- Pancreatic necrosis
- Pseudocyst (mx: observe (12w) → cystogastrostomy / aspiration)
- Abscess: due to infection of pseudocyst, (mx: trans-gastric drainage / endoscopic drainage)
- Pancreatic haemorrhage
- Ascites
- Pseudoaneurysm
- Venous thrombosis
- Chronic pancreatitis
- Enteropancreatic fistulae
Systemic:
- Diabetes mellitus (late stage as endocrine parts survive much longer than exocrine components)
- Hypocalcaemia
- Hypoglycaemia
Pleural effusions - exudative

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11
Q

Prognosis for acute pancreatitis

A

Dependent on severity
Mortality of 50% for haemorrhagic pancreatitis
Mortality 5%, rising to 35% for patients with severe disease
20% follow severe fulminating course with high mortality
80% run milder course with 5% mortality
Men with alcoholic pancreatitis much higher risk of developing chronic pancreatitis

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12
Q

Features of IgG4 related disease

A

Autoimmune pancreatitis
large numbers of IgG4 positive plasma cells
These patients respond very well to steroids

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