Acute Pancreatitis Flashcards Preview

Gastrointestinal Conditions > Acute Pancreatitis > Flashcards

Flashcards in Acute Pancreatitis Deck (18):
1

What is acute pancreatitis?

Acute inflammation of the pancreas releasing enzymes that cause autodigestion of the organ

2

Pathophysiology of pancreatitis:

Self-perpetuating enzyme-mediated pancreatic autodigestion

Oedema and fluid shifts cause hypovolaemia

ECF trapped in GUT, peritoneum and retroperitoneum

3

Causes of acute pancreatitis:

GET SMASHED

Gallstones (35%)
Ethanol (35%)
Trauma (1.5%)

Steroids
Mumps
Autoimmune (PAN)
Scorpion venom
Hyperlipidaemia, hypothermia, hypercalacaemia
ERCP (5%) and emboli
Drugs
Azathioprine
Sulphonamides
Loop diuretics

4

Symptoms of acute pancreatitis

Severe LUQ/central abdo pain

* Sudden onset
* Radiating to back
* Sitting forward relieves
* Occasionally encircles abdomen
* Decreases in intensity over 72h

Associated prominent vomiting

5

Signs of acute pancreatitis:

* Tachycardia
* Fever
* Jaundice
* Shock
* Ileus
* Abdominal rigidity
* Local/general abdo tenderness
* Cullen's sign (periumbilical bruising)
* Grey turner's sign (flank bruising)

6

Differential diagnosis of acute pancreatitis:

* Atypical MI
* Small bowel obstruction
* Small bowel perforation
* Ruptured/dissecting AAA

7

Investigations for acute pancreatitis

1. Amylase
2. Lipase
3. Bloods: CRP, LFTs, FBC, U&E, Ca2+, Glucose
4. ABG
5. AXR
6. CXR
7. CT (gold standard imaging)
8. ERCP

8

Amylase cut off for the diagnosis of acute pancreatitis:

3x upper limit

But can be normal even in severe pancreatitis

9

What other conditions cause amylase levels to rise:

* Cholecystitis
* Mesenteric infarction
* GI Perforation
* AKI/CKD (renally excreted)

But to a lesser extent than pancreatitis

10

A more sensitive and specific test for pancreatitis than amylase?

Lipase

11

Which elevated blood test predicts a high severity of pancreatitis when elevated at 36h?

CRP >150

12

Findings on plain AXR in acute pancreatitis:

No psoas shadow

Sentinel loop of proximal jejunum

13

Gold standard imaging in acute pancreatitis to assess for severity and complications:

CT

14

Management of acute pancreatitis:

NBM

Consider NJ feeding

IV fluids

Catheterisation (maintain UO >30ml/h)

Analgesia: Pethidine/morphine

Consider CVP monitoring

ABX in severe cases

ERCP + gallstone removal

Debridement (necrosectomy) if abscess formation/necrosis

15

Early complications of acute pancreatitis:

Shock
ARDS
AKI
DIC
Sepsis
Hypoglycaemia
Hyperglycaemia

16

Late complications of acute pancreatitis:

Pancreatic necrosis
Infection
Pseudocyst formation
Pancreatic abscess
Haemorrhage
Thrombosis -> bowel necrosis
Fistulae
Recurrent oedematous pancreatitis

17

Prognostic tool in acute pancreatitis:

Modified Glasgow Criteria

3+ positive factors within 48h of onset suggest severe pancreatitis

PaO2<8
Age>55
Neutrophilia (WCC>15)
Calcium<2
Renal function (U>16)
Enzymes (LDH>600, AST>200)
Albumin <32g/L
Sugar (BM>10)

18

Interventional management of acute pancreatitis

ERCP + gallstone removal

Surgical debridement - Necrosectomy (if necrosis or abscess formation)