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Year Two - Gastroenterology System > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

It is defined as a condition in which there is acute inflammation of the pancreas

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2
Q

What is the pathophysiological cause of acute pancreatitis?

A

This inflammation is due to enzyme-mediated autodigestion, caused by hypersecretion or an accumulation of exocrine digestive enzymes - amylase and lipase

This leads to necrosis of pancreatic tissue

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3
Q

What are the three classifications of acute pancreatitis?

A

Mild Acute Pancreatitis

Moderate Acute Pancreatitis

Severe Acute Pancreatitis

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4
Q

What is mild acute pancreatitis?

A

It is defined as pancreatitis associated with no organ dysfunction or complications

It resolves normally within a week

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5
Q

What is moderate acute pancreatitis?

A

It is defined as pancreatitis initially associated with some evidence of organ dysfunction

However, it improves within a period of 48 hours

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6
Q

What is severe acute pancreatitis?

A

It is defined as pancreatitis associated with persistent organ dysfunction, for a period greater than 48 hours, with local/systemic complications

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7
Q

What are the ten causes of acute pancreatitis?

A

GET SMASHED

Gallstones
Ethanol
Trauma

Steroids
Mumps/Malignancy
Autoimmune Disease, Alcohol
Scorpion Venom
Hypertriglyceridemia/Hypercalcaemia/Hyperchylomicronaemia/Hypothermia
ERCP
Drugs

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8
Q

What eight drugs are associated with acute pancreatitis?

A

Azathioprine

Mesalazine

Bendroflumethiazide

Furosemide

Sodium Valproate

Didanosine

Pentamidine

Corticosteroids

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9
Q

What are the two most common causes of acute pancreatitis?

A

Gallstones

Alcohol

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10
Q

What are the five risk factors for acute pancreatitis?

A

Male Gender

Older Age

Obesity

Alcoholism

Smoking

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11
Q

What are the eight clinical features associated with acute pancreatitis?

A

Sudden, Severe Epigastric Pain

Back Pain Radiation

Nausea & Vomiting

Appetitie Reduction

Abdominal Distension

Reduced Bowel Sounds

Cullen’s Sign

Grey Turner’s Sign

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12
Q

How is abdominal distension and reduced bowl sounds associated with acute pancreatitis?

A

In cases where there is an obstructive cause, ileus (bowel obstruction) can occur

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13
Q

What is Cullen’s sign?

A

It is defined as peri-umbilical bruising, due to intraperitoneal haemorrhage

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14
Q

What is Grey Turner’s sign?

A

It is defined as flank bruising, due to retroperitoneal haemorrhage

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15
Q

What are the four investigations used to diagnose acute pancreatitis?

A

Blood Tests

Ultrasound Scan

Chest X-Ray (CXR)

CT Scan

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16
Q

What two blood test results indicate acute pancreatitis?

A

Increased Serum Lipase Levels > 3x Normal Level

Increased Serum Amylase Levels > 3x Normal Level

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17
Q

Which blood test is first line in cases where patients present with suspected acute pancreatitis > 24 hours?

A

Lipase

This is due to the fact that serum lipase has a longer half life than amylase

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18
Q

What are the five other causes of raised amylase?

A

Pancreatic pseudocyst

Mesenteric infarct

Perforated viscus

Acute cholecystitis

Diabetic ketoacidosis

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19
Q

How are ultrasound scans used to diagnose acute pancreatitis?

A

They are the first line investigation used to identify causes of acute pancreatitis, such as gallstones and biliary obstruction

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20
Q

Why can ultrasound scans not be used to assess the pancreas?

A

This is due to the presence of bowel gas often obscuring the pancreas

21
Q

What is the feature of acute pancreatitis on CXR?

A

Pneumoperitoneum

22
Q

What is pneumoperitoneum?

A

It is free gas under the diaphragm

23
Q

When are CT scans recommended to investigate acute pancreatitis?

A

They are conducted 48 – 72 hours after the initial presentation, in cases where patients don’t clinically improve

24
Q

How are CT scans used to diagnose acute pancreatitis?

A

It is used to assess for other causes of severe abdominal pain and assess for complications of pancreatitis

25
Q

What criteria is used to diagnose acute pancreatitis?

A

‘International Association of Pancreatology’

26
Q

What does the ‘International Association of Pancreatology’ acute pancreatitis criteria state in terms of diagnosis?

A

It states that two of the three criteria must be met in order for a diagnosis of acute pancreatitis to be obtained…

Sudden, Severe Epigastric Pain

Serum Amylase/Lipase x3 Normal Levels

Imaging Findings Characteristic To Acute Pancreatitis

27
Q

What two scoring systems are used to prognosticate acute pancreatitis?

A

Glasgow Imrie Score

Ranson’s Criteria

28
Q

What is the Glasgow Imrie score?

A

It score is used to assess the severity of acute pancreatitis

29
Q

What Glasgow Imrie score indicates severe acute pancreatitis?

A

> 3

30
Q

What are the eight Glasgow Imrie score criteria?

A

PANCREAS

PaO2 < 7.9

Age > 65

Neutrophils > 15

Calcium < 2

Renal Function, Urea > 16

Enzymes, LDH > 600

Albumin < 32

Sugar > 10

31
Q

What is Ranson’s criteria?

A

It is used to predict the mortality of acute pancreatitis

It uses a smaller range of clinical and biochemical markers; first at admission then again at 48 hours, to generate a predictive mortality score

32
Q

What are the six poor prognostic criteria of acute pancreatitis?

A

Age > 55

Hypocalcaemia

Hyperglycaemia

Hypoxia

Neutrophilia

Increased LDH, AST Levels

33
Q

Which blood test level is not used to predict prognosis of acute pancreatitis?

A

Acute amylase

34
Q

What are the four immediate management options of acute pancreatitis?

A

IV Fluid Resuscitation

IV Analgesia (Paracetamol, Opioids)

Antiemetics

Blood Glucose Control

35
Q

What IV analgesia is administered in acute pancreatitis?

A

IV Morphine 1-2mg boluses until comfortable

36
Q

How do we nutritionally manage acute pancreatitis?

A

We allow individuals to eat orally as tolerated

37
Q

What are the two management options for gallstone pancreatitis?

A

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Cholecystectomy

38
Q

What is ERCP?

A

It is an endoscopic surgical procedure used to relieve biliary obstruction

39
Q

What is cholecystectomy?

A

It is a surgical procedure that involves removal of the gallbladder

40
Q

When is cholecystectomy recommended in gallstone pancreatitis?

A

It is recommended in all patients during the same admission as the acute episode

41
Q

What are the three management options for alcohol induced pancreatitis?

A

Benzodiazepines

Anticonvulsants

Vitamin B12 Replacement

42
Q

How are benzodiazepines used to treat alcohol induced pancreatitis?

A

They are the first line pharmacological option for treating alcohol withdrawal syndrome

43
Q

Name two benzodiazepines used in acute pancreatitis

A

Chlordiazepoxide

Diazepam

44
Q

How are anticonvulsants used to treat alcohol induced pancreatitis?

A

They are the second line pharmacological option for treating alcohol withdrawal syndrome

45
Q

Name an anticonvulsant used to treat alcohol induced pancreatitis

A

Carbamazepine

46
Q

How is vitamin B12 replacement used to treat alcohol induced pancreatitis?

A

It is recommended in individuals who present with Wernicke’s encephalopathy or Korsakoff’s syndrome

47
Q

What thiamine replacement therapy is used in alcohol induced pancreatitis?

A

Intravenous high-dose Pabrinex

This should be followed by regular lower doses of oral thiamine

48
Q

What are the seven complications of acute pancreatitis?

A

Necrotising Pancreatitis

Pancreatic Pseudocysts

Pancreatic Abscess

Pancreatic Insufficiency

Chronic Pancreatitis

Portal Vein/Splenic Thrombosis

Acute Respiratory Distress Syndrome (ARDS)

49
Q

What is a pancreatic pseudocyst?

A

It is a cyst is surrounded in granulation tissue

This is in contrast to a true cyst which is surrounded with epithelial tissue

Year Two - Gastroenterology System (33 decks)

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