Acute & Chronic pancreatitis Flashcards Preview

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Flashcards in Acute & Chronic pancreatitis Deck (21):
1

Cause

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune (PAN)
Scorpion stings
Hyperlipidaemia
ERCP
Drugs

ERCP is a dye infection (iatrogenic)

2

what is severe disease most commonly caused by

gallstones + alcohol

3

where do the pancreatic and bile ducts join?

at the ampulla of Vater

4

what pancreatic enzymes do the acinar cells produce?

lipase
colipase
amylase
proteases

5

difference between acute and chronic

acute - occurs in the background of a previously normal pancreas, and it returns to normal after the episode. Isolated + recurrent attacks. (25% develop severe acute)

chronic, continuing inflammation with irreversible structural changes

6

Pathogenesis acute pancreatitis

Elevated intracellular calcium

Cascade release of inflammatory cytokines + pancreatic enzymes

Acinar cell injury + necrosis

Inflammatory response

potentially --> SIRS
(single/multiple organ failure)

7

Classification of acute pancreatitis

oedematous
severe/necrotizing
haemorrhagic

8

Phlegmon

spreading inflammatory process with formation of pus abscesses

associated with oedematous

9

Pseudocyst

persistant pancreatic fluid collect which may eventually become infected

associated with severe/necrotising

10

presentation acute

severe epigastric pain --> back
nausea, anorexia + vomiting

fever, dehydration, hypotension, tachycardia - SEPTIC CHOCK

11

what signs in haemorrhagic? (acute)

Grey turner's sign - bruising of the flanks

Cullen's sign - bruising round the umbilicus

12

Diagnostic criteria acute

2 or 3 out of the following:
- severe epigastric pain--> back

- Serum amylase of >1000U (shouldn’t be used in isolation)

- Abd CT scan pathology e.g. loss of fat planes/pancreatic edema and swelling, fluid loculations (small compartments)

13

Tx acute

Analgesia (pethidine + tramadol)
Catheterise
O2, LMWH
Antibiotics (ref/met)
Bowel rest
Nutrition (NG/IV)
Fat soluble vitamins

14

Complications acute

SIRS
MODS
Pseudocyst
Diabetes
Biliary obstruction etc.

15

Scoring system acute

Glasgow

16

Pathogenesis chronic

unclear

excess alcohol is most common cause

?obstruction/reduction of HCO3- excretion (CF or trauma?) --> activation of pancreatic enzymes --> pancreatic tissue necrosis --> fibrosis

?alcohol --> proteins precipitate in the pancreatic ducts --> local dilatation + fibrosis?

17

Dx chronic

USS + CT (pancreatic calcifications confirm the Dx)

18

Tx chronic

ERCP - Endoscopic retrograde cholangiopancreatography

- tube/stent across duct stricture/ remove pancreatic stones

drainage of persistent pseudocysts

19

Autoimmune chronic pancreatitis

high prevalence in japan
raised serum gammaglobulins and IgG

steroid-responsive and reversible

20

In acute, what would an erect CXR be ruling out?

to exclude perforated peptic ulcer as the cause of the pain and raised amylase

21

why is morphine avoided as an analgesic?

it increases sphincter of oddi pressure, and may aggregate pancreatitis