Acute pancreatitis Flashcards
Why is acute pancreatitis a critical differential diagnosis for a patient presenting with abdominal pain?
High morbidity + mortality, especially if diagnosed late
Causes?
GET SMASHED:
- Gallstones (most common worldwide)
- Ethanol (most common Europe)
- Trauma
- Steroids
- Mumps
- Autoimmune disease (Polyarteritis nodosa/SLE)
- Scorpion bite
- Hypercalcaemia, hypertriglyceridaemia, hypothermia
- ERCP
- Drugs (FATSHEEP)
Drugs that cause acute pancreatitis?
FAT SHEEP:
- Furosemide
- Azathioprine/asparaginase
- Thiazide/tetracycline
- Statins/sulfonamides/sodium valproate
- Hydrochlorothiazide
- Estrogens
- Ethanol
- Protease inhibitors + NRTIs
Classic sign?
Stabbing/severe epigastric pain:
- radiates to the back
- worse lying down (better sitting forward)
Symptom alongside pain?
Vomiting
Signs?
- Fever (if infected)
- Guarding (non-specific)
- Grey-Turners sign (rare but indicative) - bruising at flanks indicating retroperitoneal bleed
- Cullen’s sign (indicative) - peri-umbilical bruising
What can third space fluid sequestration in pancreatitis lead to?
- ARDS
- pleural effusions
- hypovolaemia –> AKI
Bloods?
(1) FBC, U&Es - leukocytosis = nectrotising pancreatitis
(2) LFTs = abnormal if gallstone
(3) Lipase - sensitive + specific, not always available
(4) AMYLASE - 3x normal
Imaging if suspected gallstones?
US abdomen
Imaging if suspected obstructive pancreatitis?
MRCP or ERCP
If complications such as pseudocysts or nectrozing pancreatitis are suspected, what imaging?
CT abdomen
Criteria for severity of pancreatitis? When do you perform?
Modified Glasgow Criteria - usually at admission then after 48hrs
Which score indicates transfer to HDU/ITU?
3+
Outline the modified Glasgow Criteria?
PANCREAS:
- PaO2 <8kPa
- Age >55
- Neutrophils >15x10*9/L
- Calcium <2mmol/L
- Renal function - urea >16
- Enzymes - AST/ALT >200, LDH >600
- Albumin <32g/L
- Sugar/glucose >10mmol/L
Mainstay of management?
Fluid resus to compensate for third space losses
