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finals: surgery > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

Pancreatitis refers to

A

inflammation of the pancreas

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2
Q

Name the two categorises of pancreatitis

A

Acute pancreatitis

Chronic pancreatitis

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3
Q

How can acute pancreatitis be distinguished from chronic pancreatitis

A

Acute pancreatitis has limited damage to the secretory function of the gland with no gross structural damage

Whereas, chronic pancreatitis has progressive and permanent deterioration in pancreatic function

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4
Q

What is the difference between acute and chronic pancreatitis in terms of onset of inflammation and symptoms

A

Acute pancreatitis: rapid onset of inflammation and symptoms

Chronic pancreatitis: longer-term inflammation and symptoms

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5
Q

Name the 3 most common causes of pancreatitis

A

Gallstones

Alcohol

Post-endoscopic retrograde cholangiopancreatography (ERCP)

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6
Q

What is the mnemonic for the causes of acute pancreatitis

A

I GET SMASHED

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7
Q

Name the causes of acute pancreatitis

A

Mnemonic: I GET SMASHED

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8
Q

What is the most common cause of acute pancreatitis

A

Gallstones

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9
Q

How does gallstones cause acute pancreatitis

A
  • Gallstones migrate from the gallbladder to the biliary tree where they may cause obstruction of the ampulla
  • The biliary reflux and raised pressures following from the obstruction are responsible for the resultant pancreatitis
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10
Q

What is the mechanism in which alcohol can cause pancreatitis

A

Alcohol has toxic effects on the pancreas

The exact mechanism by which it causes pancreatitis remains unclear

Commonly causes chronic pancreatitis with alcoholics suffering acute-on-chronic attacks

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11
Q

What is the most common cause of chronic pancreatitis

A

Alcohol abuse

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12
Q

Describe the pathophysiology of pancreatitis

A

Pancreatitis occurs due to the abnormal release of activated pancreatic enzymes within the pancreas resulting in autodigestion of pancreatic tissue

Trypsin is the key pancreatic enzyme that is involved in the development of pancreatitis

Normally, the pancreas releases zymogens i.e. inactive enzyme precursors e.g. trypsinogen

In pancreatitis, normal zymogen transport fails and trypsinogen is converted to trypsin within the pancreas leading to a cascade of zymogen activation within the pancreas

This triggers the recruitment of inflammatory cells and the release of inflammatory mediators

The resulting pancreatic inflammatory response causes an increase in vascular permeability and subsequent fluid shifts

Enzymes are released from the pancreas into the systemic circulation, causing autodigestion of fats (resulting in a ‘fat necrosis’) and blood vessels (sometimes leading to haemorrhage in the retroperitoneal space).

Fat necrosis can cause the release of free fatty acids, reacting with serum calcium to form chalky deposits in fatty tissue, resulting in hypocalcaemia

Severe end-stage pancreatitis will eventually result in partial or complete necrosis of the pancreas

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13
Q

Which pancreatic enzyme is the key enzyme involved in the development of pancreatitis

A

Trypsin

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14
Q

Describe the pain associated with acute pancreatitis

A

Sudden onset of severe epigastric pain

Radiating through to the back

Worsened on movement

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15
Q

Name the two signs of acute pancreatitis

A

Cullen’s sign

Grey-Turner’s sign

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16
Q

Cullen’s sign is indicative of which condition

A

Acute pancreatitis

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17
Q

Grey-Turner’s sign is indicative of which condition

A

Acute pancreatitis

18
Q

Define Cullen’s sign

A

Bruising around the umbilicus

Indiciative of acute pancreatitis

19
Q

Define Grey-Turner’s sign

A

Flank bruising

Indiciative of acute pancreatitis

20
Q

How is acute pancreatitis diagnosed

A

Clinical diagnosis, based on the clinical features and the amylase level

21
Q

Serum amylase is a blood test.

Elevated 3 times above the reference range is considered diagnostic for condition?

A

Acute pancreatitis

22
Q

What risk scoring tool is used to assess the severity of acute pancreatitis within the first 48 hours of admission

A

Glasgow score

23
Q

Name some of the criteria of the Glasgow score for acute pancreatitis

A
  • Mnemonic: PANCREAS (1 point for each answer):

P – Pa02 < 8 KPa

A – Age > 55

N – Neutrophils (WBC > 15)

C – Calcium < 2 mmol/L

R – Renal function (urea >16 mmol/L)

E – Enzymes (LDH > 600U/L or AST/ALT >200U/L)

A – Albumin < 32g/L

S – Sugar (Glucose >10mmol/L)

24
Q

Name some of the conditions in which serum amylase is raised

A

Acute pancreatitis - need to know

Bowel perforation

Ectopic pregnancy

Diabetic ketoacidosis

25
Q

What is the function of the pancreatic amylase

A

Role in the breakdown of carbohydrates

26
Q

Describe the term “missed peak” in terms of serum amylase for acute pancreatitis

A

‘missed peak’ refers to a fall in serum amylase after 3 days of acute pancreatitis

Patients who present late may have a missed peak as their serum amylase was acutely rised however it is now normal

27
Q

Why is serum lipase more sensitive than serum amylase for acute pancreaitits

A

Lipase has a longer half-life and as such levels remain elevated longer than amylase

Raised levels are also more specific for pancreatic disease than amylase

28
Q

What is the mainstay of management for patients with acute pancreatitis

A

There is no curative management for acute pancreatitis, so supportive measures are the mainstay of treatment

Treating the underlying cause e.g., gallstone, should be addressed, once the patient has been stabilised

29
Q

When should prophyalytic antibiotic therapy should be commenced in acute pancreatitis

A

Antibiotics should only be used as prophylaxis in cases of suspected/confirmed infected pancreatic necrosis, cholangitis or another infective source

30
Q

Name the 3 supportive management in acute pancreatitis

A
  • IV fluids – remember fluid balance
  • Analgesia – morphine can be used but it may lead to spasm of the sphincter of Oddi
  • Nutritional support
31
Q

Name the three local complications of acute pancreatitis

A

Necrosis of the pancreas

Pancreatic pseudocyst formation

Chronic pancreatitis

32
Q

Describe pancreatic necrosis

A

Continued inflammation may lead to localised thrombosis, haemorrhage and necrosis within the pancreas

33
Q

What is the gold standard investigations for pancreatic necrosis

A

CT guided fine needle aspiration and culture

34
Q

What is the management for pancreatic necrosis

A

Culture positive patients are generally managed with appropriate antibiotics guided by microbiology

Drainage or surgical debridement may be required.

35
Q

Define the term “pancreatic pseudocyst”

A
  • Collections of pancreatic fluid
  • Present for 4 or more weeks after an acute episode of acute pancreatitis
36
Q

What is the management of pancreatic pseudocyst

A

Symptomatic or large pseudocysts require endoscopic, radiological or surgical management.

37
Q

Name the two vascular complications of acute pancreatitis

A

Pseudoaneurysm

Venous thrombosis

38
Q

Which vascular complication normally occurs in association with pancreatic pseudocyst

A

Pseudoaneurysm

39
Q

Which vessels is pseudoaneurysm (a complication of acute pancreatitis) often seen in

A

Splenic and hepatic arteries

40
Q

Which vessels is venous thrombosis secondary to acute pancreatitis often seen in

A

Portal, splenic and superior mesenteric veins.

41
Q

Name this sign?

What condition is it found in?

A

Cullen’s sign

Indicative of haemorrhagic pancreatitis

42
Q

Name this sign?

What condition is it found in?

A

Gray Turner’s sign

Indicative of haemorrhagic pancreatitis

finals: surgery (10 decks)

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