ACUTE PANCREATITIS Flashcards
What are most cases of acute pancreatitis caused by
gallstones and excessive alcohol consumption
what is the pathophysiology of acute pancreatitis
autodigestion of pancreatic tissue by the pancreatic enzymes , leading to necrosis
What are causes of pancreatitis
Gallstones
Ethanol
Trauma
Steroids
Mumps – other viruses like Coxsaxkie B
Autoimmune, Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia(genetic ),
Hypercalcaemia, Hypothermia
ERCP
Drugs
What drugs cause acute pancreatitis
Azathioprine ,
mesalazine ,
didanosine ,
bendroflumethiazide
furosemide
pentamidine
steroids
sodium valproate
What are other diagnostic factors
signs of organ dysfunction
-exocrine dysfunction – steatorrhoea and diarrhoea
dyspnoea
jaundice
What are key diagnostic factors
upper abdominal pain radiating to back
nausea and vomitting
signs of hypovolemia - hypotension, oliguria, dry mucous membranes , decreased skin turgor, sweating
signs of pleural effusion
anorexia
Cullens sign - periumbilical discolouration
Grey turner sign- flank discolouration
What are the 2 key investigations for acute pancreatitis
serum amylase – 3x upper limit
Transabdominal ultrasound- rarely used in acute setting to investigate epigastric pain
What are other key investigations
FBC - leukocytosis and elevated haematocrit indicates poor prognosis
Contrast enhanced CT
elevated CRP – >200MG/L associated with pancreatic necrosis
pulse oximetry
LFTs
Erect CXR– rules out perforated viscus
What factors indicate severe pancreatitis
age >55years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
How to medically manage acute pancreatitis
fluid resuscitation with crystalloids
analgesia with IV opioids
nutritional support - start oral feeding / consider insertion of NG tube and slow enteral feeding
consider oxygen and anti-emetic
IV antibiotics if infected pancreatic necrosis or signs of sepsis
blood gas analysis - fundamental to pancreatitis severity scoring
What surgical options are there to treat acute pancreatitis
If due to gallstones- early cholecystectomy
If obstructed biliary system due to stones - ERCP
debridement if there is necrosis and worsening organ dysfunction
infected necrosis - drainage
What are some local complications of acute pancreatitis
-peripancreatic fluid collections
-pseudocysts
-pancreatic necrosis
-pancreatic abscess
-haemorrhage
Peripancreatic fluid collection ?
-occurs in 1/4 cases
-located in/near pancreas and lack a wall of granulation or fibrous tissue
-either resolve or develop into pseudocysts/ abscesses
-majority resolve
Pseudocysts?
collection of fluid that IS walled by fibrous or granulation tissue
most are retrogastric
75% associated with persistent mild elevation of amylase
Investigation is with CT,ERCP,MRI or USS
Treatment is either with
1. endoscopic ultrasounds 2. surgical cystogastrostomy
3.aspiration
Pancreatic necrosis
-may involve both pancreatic parenchyma and surrounding fat
-early necrosectomy is associated with high mortality rate - should be avoided
