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Acute Pancreatitis Flashcards

(58 cards)

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1
Q

define acute pancreatitis

A

acute inflammation of the pancreas

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2
Q

main features of the pancreas

A

exocrine and endocrine gland
sits in retro peritoneum behind the stomach
has a close relationship with major vascular and biliary structures

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3
Q

mortality of acute pancreatitis

A

majority are self limiting
mortality is 20-30% of those who develop infected necrosis of pancreas

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4
Q

auto digestion of the pancreas

A

usually related to activation of trypsinogen
fusion of zymogens with lysosomes activates enzymes (colocalisation)
fusion is mediated by calcium influx

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5
Q

signals that may cause calcium influx

A

ductal hypertension
NF-kB
ethanol metabolites
low pH

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6
Q

local response of auto digestion

A
  • inflammation and pain
  • oedema and fluid leak
  • tissue damage and necrosis
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7
Q

systemic response of auto digestion

A

systemic inflammatory response syndrome (SIRS)
near by organs can be obstructed or paralysed

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8
Q

inflammatory cascade

A

local vasodilation and increase in permeability
oedema
vascular injury and hypo perfusion
ischaemia and tissue necrosis

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9
Q

SIRS

A

systemic inflammatory response syndrome
systemic release of IL1 and TNFa

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10
Q

essential pathophysiology of acute pancreatitis

A
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11
Q

trypsin activates

A

lipase
phospholipase A
elastase
chymotrypsin
kvllikrein-kinin lipase

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12
Q

lipase causes

A

fat necrosis

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13
Q

phospholipase A causes

A

coagulation, destroys cell membranes

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14
Q

elastase causes

A

vascular damage and haemorrhage

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15
Q

chymotrypsin causes

A

oedema and vascular damage

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16
Q

kallikrein-kinin lipase causes

A

oedema and inflammation

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17
Q

leading causes of acute pancreatitis

A

alcohol and gallstones

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18
Q

other causes of acute pancreatitis

A

idiopathic
autoimmune
metabolic (hypertriglyceridaemia and hypercalcaemia)
malignancy
ERCP
drug induced
traumatic
viral
bacterial and parasites

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19
Q

virusess that might cause pancreatitis

A

mumps, coxsackie B, rarely HIV, Hep

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20
Q

for diagnosis of acute pancreatitis

A

you need presence of 2 of:
- pain typical of pancreatitis
- serum lipase 3x normal value
- imaging confirming inflammation of the pancreas (can be enough on its own)

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21
Q

why is amylase not sensitive

A

has shorter half life

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22
Q

2 types of acute pancreatitis

A
  • interstitial oedematous pancreatitis
  • necrotising pancreatitis
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23
Q

interstitial oedematous pancreatitis

A

diffuse gland enlargement
fluid collections can happen
uniform enhancement of the gland

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24
Q

necrotising pancreatitis

Study These Flashcards
A

usually involves necrosis of both gland and peripancreatic tissue
rarely pancreas only
needs days to evolve and confirm
associated with higher mortality

25
at what point should imaging be conducted
should not be conducted early eg. necrotising pancreatitis needs days to evolve and confirm so early CT is unreliable best beyond the 5th day perfusion is impaired in early phases
26
early phase of acute pancreatitis
1 week usually relates to SIRS and acute inflammatory process can have systemic effects and organ failure
27
late phase of acute pancreatitis
persistence of systemic complication and organ failure evolution of local complications and progression
28
mild acute pancreatitis
interstitial oedema and rapid recovery no necrosis, complications or organ failure
29
moderate acute pancreatitis
local complications (necrosis, feud collection, pseudocysts) OR systemic complications (temporary organ failure eg. kidney) improving within 48 hours
30
severe pancreatitis
persistant single or multi organ failure >48 hours
31
complications in pancreatic region
fluid collections around pancreas necrosis of tissue infection of fluid or necrosis
32
pancreatic pseudocyst is
fibrous capsule containing sterile lipase rich fluid collection
33
what is chronic pancreatitis
long term outcome of scarring and obstruction of parenchyma or ducts
34
luminal complications
gastric outlet obstruction colonic stricture colonic performaation biliary obstruction
35
vascular complications
venous thrombosis arterial pseudo-aneurysm heamorrhage (direct or DIC)
36
compartment complications
intre-abdominal hypertension and ACS pseudo obstruction ileus
37
death typically occurs due to
death is rare usually occur in the first week as a result of SIRS and multi organ failure
38
if death occurs after the first week
rare usually due to infective complications
39
pain profile of acute pancreatitis
central epigastric pain sudden onset severe, sharp radiates through to back vomiting, anorexia constant from onset worse with movement mild to severe
40
signs and risk factors for pancreatitis
gall stones; recent cholecystectomy or Hx of biliary colic alcohol drugs systemic signs of hypercalcaemia or malignancy family Hx recent procedures
41
what are systemic signs of hypercalcaemia
constipation, kidney stones
42
mild pancreatitis on examination
mild tachycardia acute abdo pain minimal abdo distention central upper abdo/epigastric tenderness
43
severe pancreatitis on examination
tachycardia, fever, hypotension severe acute abdominal pain peritonism
44
Cullen's sign
periumbilical eccymosis and discolouration (bluish-red)
45
grey turner's sign
flank ecchymosis with discolouration
46
fox's sign
ecchymosis over the inguinal ligament
47
glasgow prognostic criteria of acute pancreatitis
assessed in the first 48 hours
48
APACHE II severity predictor
commonly used in ICU score >8 is clinically severe immediate but many people with severe disease score low
49
CRP severity predictor
15omg/L is usual cut off for severity usually peaks at 48 hours
50
PCT severity predictor
procalcitonin good marker for infection
51
CT scan scoring as a severity predictor
confirms local complications and severity
52
fluid resuscitation
must be balanced - enough to maintain organ perfusion - avoid over load and resultant organ dysfunction and increase risk of intra abdominal hypertension - CSL is preferred crystalloid
53
nutrition
NBM/sips only - resting the gland might help disease progression - limited to 24-48 hours enteral nutrition is best - normal route - beyond the duodenum with nasojejunal tube in severe case - keeps the gut occupied to prevent bacterial translocation TPN when gut not working
54
ERCP is indicated in
gallstone pancreatitis with cholangitis best in the first 72 hours as proven reduction in mortality has no role in other conditions and may increase complications
55
cholecystectomy is indicated in
gall stone pancreatitis
56
when to perform cholecystectomy
immediately in mild pancreatitis in moderate or severe, should wait for recovery
57
only intervene in pseudocysts if
three S's - Symptomatic - greater than Six cm - longer than Six weeks
58
when to intervene in management of local complications
proven infection that won't respond to antibiotics failure of recovery symptomatic collections (large and painful or gastric outlet obstruction)

Surgery (18 decks)

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