Acute Pancreatitis Flashcards
what are the causes
GET SMASHED- gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion venom, hyperlipidaemia hypothermia hypercalcaemia, ERCP/ emboli, drugs
symptoms
gradual or sudden severe epigastric or central abdo pain, radiates to the back relieved by sitting forward. vomiting
signs
tachycardia, fever, rigid abdomen +- local/ general tenderness, ileus, jaundice, shock, Cullens sign, Grey Turners sign
what is Cullens sign
peri umbilical bruising
what is Grey Turners sign
flank bruising
why is there bruising in Cullens and grey turners sign
blood vessel autodigestion and retroperitoneal haemorrhage
tests
increased serum amylase >1000 or 3x normal. degree of elevation not related to severity of disease. serum lipase. ABG, AXR, CXR, CT, MRI, UR, ERCP if LFTs worsen, CRP >150 at 36h after admission predictor of severe pancreatitis
when else can serum amylase be high
cholecystitis, mesenteric infarction, GI perforation. if renal failure, increased levels as excreted renally
what is the most sensitive and specific marker for pancreatitis
serum lipase
criteria for predicting severity of pancreatitis
PANCREAS. PaO2 55; Neutrophilia WBC >15X 10^9/L; calcium 16; Enzymes- LDH >600, AST>200; Albumin 10
management
NBM, IVI 0.9% saline, insert catheter. analgesia- pethidine or morphine. hourly pulse, bp, UO, daily FBC, U&E, ca, glucose, amylase, ABG
what should you do if suspected abscess or pancreatic necrosis
parenteral nutrition +- lap and debridement. imipenem
DDX
any acute abdomen, MI
early complications
shock, sepsis, DIC, ARDS, low calcium, renal failure, high glucose
late complications
pancreatic necrosis and pseudocyst, abscess, bleeding, thrombosis, fistulae
