Acute Pancreatitis Flashcards
What are the causes of acute pancreatitis?
Get smashed Gall stones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings Hyperlipidaemia, hypothermia, hypercalcaemia ERCP drugs
What are the symptoms of acute pancreatitis?
Gradual or sudden severe epigastric pain that radiates to the back, may be relieved by sitting forwards
Often includes vomiting
What are some of the signs of acute pancreatitis?
Can be subtle in serious disease Increased Hr Jaundice Fever Shock Bruising around umbilicus or flanks from vessel autodigestion
What is cullens sign?
Periumbilical bruising caused by autodigestion of vessels
What are the tests for acute pancreatitis?
Serum Amylase over 1000u/ml however level of increase is not related to severity of pancreatitis, also may not be raised in severe pancreatitis. Lipase is more sensitive and specific and rises earlier and falls later.
Abg to measure oxygenation and acid-base status
Axr- no psoas shadow from retroperitoneal fluid
CT standard choice for imaging to assess severity and for complications
ECR - to exclude perforation
What is the management of acute pancreatitis?
Nil by mouth to decrease pancreatic stimulation
IVI of crystalloid to maintain vitals
Insert urinary catheter and maintain flow >30ml/h
Analgesia -pethidine or morphine
Hourly obs, FBC, u and e, calcoum, glucose, amylase and abg
If worsening consider it
Pancreatic Necrosis on ct then consider laprotomy and debridement
ERCP and gallstone removal may be needed in progressive jaundice
What are the early complications of acute pancreatitis?
Shock, renal failure (give lots of fluids), sepsis, dic, hypocalcaemia, hypoglycemia
What are the late complications of acute pancreatitis?
Pancreatic necrosis/pseudocyst
Bleeding from autodigestion
Thrombosis
How do you predict the severity of acute pancreatitis?
Modified Glasgow criteria Pneumonic pancreas PaO2 <8kPa Age >55yrs Neutrophilia WBC >15x10^9 Calcium <2mmol/L Renal function - urea >16mmol/L Enzymes LDH >600iu/L Albumin <32g/L serum Sugar - blood glucose > 10mmol/L
What is grey turners sign?
Bruising around the flanks
