Acute pancreatitis Flashcards
How common is it?
Accounts for 3% of all cases of abdominal pain admitted to hospital. It affects 2–28 per 100 000 of the population and is increasing in incidence.
Who does it affect?
Age >55y
BMI >30
Alcohol abuse
What causes it?
Acute pancreatitis occurs as a consequence of premature intracellular trypsinogen activation, releasing proteases which digest the pancreas and surrounding tissue.
What risk factors are there (and how can they be reduced)?
Excessive alcohol consumption Gallstones Pancreatic duct obstruction Certain drugs Post surgery Infection (mumps, coxsackie) Metabolic causes
How does it present? What symptoms should you look out for?
- Severe, constant upper abdominal pain of increasing intensity over 15-60 mins, radiating to the back
- Nausea and vomiting common
- Anorexia
- Diarrhoea
- Fever
What signs may the patient have on examination?
- Epigastric tenderness
- in early stages guarding and rebound tenderness usually absent, but may appear later
- Bowel sounds quiet or absent
- Fever
- Tachycardia
Sometimes:
- Jaundice
- Dyspnoea
- Pleural effusions
Rarely (necrotising pancreatitis):
- Grey Turner’s sign (discolouration of flanks)
- Cullen’s sign (periumbilical discolouration)
Which other conditions might present similarly?
Acute Mesenteric Ischemia Acute Respiratory Distress Syndrome Bacterial Pneumonia Cholangitis Cholecystitis Chronic Pancreatitis Colon Cancer Colonic Obstruction Community-Acquired Pneumonia (CAP) Gallstones (Cholelithiasis) Gastric Cancer Irritable Bowel Syndrome Myocardial Infarction Pancreatic Cancer Pancreatic Pseudocysts Peptic Ulcer Disease Viral Hepatitis
How would you investigate this patient?
Serum amylase/lipase Pancreas US/contrast CT Plain x-ray (exclude other causes) CRP (predicts prognosis) Blood cultures (if infection suspected) LFTs
What would you tell the patient and how would you explain the condition to them?
The pancreas is an abdominal organ that secretes enzymes. For what ever reason (alcohol etc) these enzymes are now causing the pancreas to become inflamed
How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?
The diagnosis can be very frightening and the patient/family may be worried about prognosis/recovery.
The patient may have to take a lot of time off sick.
What questions are they likely to have?
Why did this happen?
Is there anything I can do to stop it from happening again?
How long will it take for me to get better?
What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?
Opiates for pain IV fluids Insulin for hyperglycaemia NG aspiration if paralytic ileus Enteral feeding in severe cases Abx in necrotising cases Cholecystectomy in cases caused by gallstones
