Acute and Chronic Pancreatitis? Flashcards
(24 cards)
What is pancreatitis?
Syndrome of inflammation of the pancreatic gland initiated by any acute injury. Difficult to differentiate between chronic and acute.
What are the three types of pancreatitis?
- Oedematous
- Necrotising
- Hemorrhagic
Briefly describe the pathophysiology of pancreatitis?
- Premature activation of pancreatic enzymes cause pancreatic inflammation by autodigestion
- These enzymes can also digest vessels leading to leakage into the tissues causing oedema, inflammation and hypovolaemia
What are the two causes of pancreatitis?
- Alcohol
- Gallstones
How do gallstones cause pancreatitis?
Accumulation of enzyme rich fluid within the pancreas due to obstruction - intracellular Ca increased and causes early activation of trypsinogen
How does alcohol cause pancreatitis?
Alcohol interferes with Ca homeostasis and enzyme secretion is increased. There is also obstruction due to contraction of the ampulla of vater
What are the risk factors for pancreatitis?
I GET SMASHED
- I - idiopathic
- G - gallstones (majority - 80%)
- E - ethanol (i.e. alcohol - 30%)
- T - trauma
- S - steroids
- M - mumps
- A - autoimmune
- S - scorpion venom
- H - hyperlipidaemia
- E - ERCP (endoscopic retrograde cholangiopancreatography)
- D - drugs (eg azathioprine, furosemide (diuretics), corticosteroids, NSAIDs, ACEIs)
What is the presentation of pancreatitis?
- Severe epigastric or central abdominal pain that radiates to the back. (Relieved by sitting forward)
- Anorexia, nausea and vomiting
- Tachycardia
- Fever
- Jaundice
What are Cullen’s and Grey Turner’s sign?
Both skin discolouration due to blood under the skin due to bruising - a sign of severe necrotising pancreatitis
Cullen’s = Periumbilical
Grey Turner’s = Left flank
What are the main investigations you would perform in suspected pancreatitis?
Blood tests and abdominal ultrasound
What would you see in the blood test for someone with acute pancreatitis?
- Raised serum amylase
- Raised serum lipase
What would you see on an abdominal ultrasound in pancreatitis?
Gallstone if gallstone cause
What factors are looked at in the Glasgow & Ransom scoring systems
- PaO2
- Age
- Neutrophils
- Calcium
- Raised Urea
- Elevated enzymes
- Albumin
- Sugar
How many factors in the Glasgow & Ransom scoring system need to be present to predict severe episode
3 or more factors present during the first 48 hours
What is the APACHE II score?
Acute physiology and chronic health evaluation - used to test severity and take into account chronic conditions
Give 3 complications of pancreatitis?
- Hyperglycaemia
- Hypocalcaemia
- Renal failure
- Shock
- ARDS
- DIC
- Pseudocyst - fluid in lesser sac)
- Thrombosis - may occur in the splenic/gastroduodenal arteries, or colic branches of the SMA, causing bowel necrosis
- Fistulae - between pancreas and lungs
What is systemic inflammatory response syndrome?
Any two of:
- Tachycardia >90bpm
- Tachypnoea >20 breaths pm
- Pyrexia with temperature above 38
- High WCC
What is the management for acute pancreatitis?
- Early fluids
- Nothing by mouth
- IV infusion
What pharmacological treatments are given in acute pancreatitis?
- Analgesia
- Prophylactic antibiotics e.g beta-lactams
- Insulin may be given if blood sugars need correcting
- Supplemental O2 if rest complications
What is chronic pancreatitis?
Irreversible fibrosis of the pancreas.
What are the risk factors for chronic pancreatitis?
- Alcohol
- Smoking
- Related to igG4 disease
What is the presentation of chronic pancreatitis?
- Severe abdo pain
- Epigastric pain radiating to the back
- Nausea and vomiting
- Decreased appetite
- Exocrine/endocrine dysfunction
What are the complications of chronic pancreatitis?
Exocrine dysfunction = Malabsorption, weight loss, diarrhoea and steatorrhoea
Endocrine dysfunction = diabetes mellitus
What is the treatment and management of acute pancreatitis?
Manage symptoms
- Opiates/painkillers
- Insulin
- Nutrition
