Flashcards in Acute pancreatitis Deck (30)
What percentage of pancreatitis cases are mild to moderate?
What is the pain like in acute pancreatitis?
steady and persistent for many hours. N/V
Pain is worse in the upper quadrants
What additional Sx will a pt with SEVERE acute pancreatitis have?
Mental status changes
Would the abdomen be rigid in pancreatitis?
NO--that's a peritoneal sign.
ecchymosis in the flank region
ecchymosis in the periumbilical region
What other things could cause an elevated amylase besides pancreatitis?
Why is the serum lipase more sensitive?
All lipase comes from the pancreas
What other labs might be abnormal
WBC high, esp in severe pancreatitis
Glucose and LFTs high if gallstones are present
What imaging tests might help?
Plain abdominal films excludes perforation and intestinal obstruction
Abdominal CT: shows inflammation of pancreas, extent of inflammation, and necrosis
What is the downside to using a CT in suspected pancreatitis?
It may be normal in 15-30% of pts with mild pancreatitis won't show early signs in CT
What criteria are used to diagnose acute pancreatitis?
1. Abdominal pain consistent with acute pancreas
2. elevated amylase/lipase 3x normal limit
3. confirmation with X-sect abd imaging
What's your differential for pancreatitis?
What are the two most common causes of acute pancreatitis?
alcohol abuse and gallstones (these comprise 80% of cases)
Do gallstones lead to chronic pancreatitis?
No--while alcohol can cause permanent structural changes, intermittent obstruction of the pancreatic duct usually does not.
What are less common causes of acute pancreatitis?
toxins (trinidadian scorpion)
What are three inherited causes of acute pancreatitis?
1. Trypsinogen mutation (loss of inactivation binding site)
2. CFTR mutations: thickened mucus causes obstruction of bile duct, inaddition to malabsorption
3. Familial hypertriglyceridemia
How do you determine the severity of pancreatitis?
Use the ranson index, with 11 variables.
What is missing from the ranson index?
amylase/lipase elevation! These are elevated both in acute and chronic cases and don't tell you more than that.
Aside from the ranson index, what other prognostic indicators are there?
-Impaired mental status
What are early complications of severe acute pancreatitis?
1. massive dehydration
2. hyperglycemia, hypocalcemia, electrolyte abnormalities, coagulopathy and hypoxia
What is SIRS?
Systemic inflammatory response syndrome: Fever, tachycardia, tachypnea, elevated WBC
What are the late complications of acute pancreatitis?
Occurs after the 2nd week. Pseudocysts, abscesses, and GI hemorrhage
-->death from SIRS/sepsis/multiorgan failure. Can occur at any time.
How do you treat sterile necrosis of the pancreas? Infected necrosis?
1. Antibiotics, conservative
2. Antibiotics, debridement
How do you treat GI hemorrhage?
Transfuse, PPI, surgery
Why might pancreatitis cause a coagulopathy?
Why might someone with pancreatitis get acute renal failure?
Hypotension, causing pre-renal or hemodynamic ARF
How do you treat mild acute pancreatitis?
Nothing by mouth
Removal of risk factors (cholecystectomy or alcohol/medication removal)
How do you treat severe acute pancreatitis?
1. fluid/electrolyte replacement
2. Pain control
3. Nutrition thru a jejunal tube
4. Antibiotics: ONLY if established infection
5. Surgery: Drainage of symptomatic pseudocysts or debridement of infected necrosis
6. Emergent ERCP is controversial for gallstone removal