Flashcards in Acute & Chronic pancreatitis Deck (21)
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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
