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Y4: Acute surgery > Acute pancreatitis > Flashcards

Acute pancreatitis Flashcards

1
Q

How can acute pancreatitis be distinguished from chronic?

A

Limited damage to secretory function

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2
Q

What are the causes of Acute pancreatitis?

A
  • I GET SMASHED
    • Idiopathic
    • Gallstones
    • Ethanol
    • Trauma
    • Steroids
    • Mumps
    • Autoimmune disease (SLE)
    • Scorpion venom
    • Hypercalcaemia
    • ERCP
    • Drugs
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3
Q

What drugs can cause acute pancreatitis?

A
  • NSAIDs
  • Azathioprine
  • Diuretics
  • Steroids
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4
Q

Describe the pathogenesis of acute pancreatitis?

A
  • Premature and excess digestive enzyme release
  • Inflammatory response causes increased vascular permeability and fluid loss
  • Enzymes cause autodigestion of fats and blood vessels
  • FFAs then react with calcium causing chalky deposits and hypocalcaemia
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5
Q

What are the features of Acute pancreatitis?

A
  • Epigastric pain -> back
  • Vomiting
  • Tenderness, ileus and low grade fever
  • Cullens and grey turners sign
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6
Q

What is cullens sign?

A
  • Periumbilical discolouration
  • Present in ectopic pregnancy and acute pancreatitis
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7
Q

What is grey turners sign?

A
  • Flank bruising / discolouration
  • Can predict a severe attack of acute pancreatitis
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8
Q

What are the invesitgations for acute pancreatits?

A

Raised serum amylase

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9
Q

Name a scoring system for pancreatitis?

A

Glasgow scale of pancreatitis severeity (PANCREAS)

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10
Q

Features of the Glasgow scale of pancreatitis severity?

A
  • PANCREAS
    • PaO2 <7.9
    • Age >55
    • Neutrophils (WBC >15)
    • Calcium (hypocalcaemia)
    • Renal function (Urea > 16)
    • Enzymes LDH > 600
    • Albumin <32
    • Sugar (blood glucose > 10)
  • More than 3 features indicates severe pancreatitis
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11
Q

Differentials for acute pancreatitis?

A
  • Sympatomatic/ruptured AAA
  • Chronic pancreatitis
  • Aortic dissection
  • Duodenal ulcer
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12
Q

What investigations should be performed for someone with a suspected acute pancreatitis?

A
  • Serum amylase (3x upper limit of normal)
  • LFTs (ALT>150 predicts gallstones are the cause)
  • Serum lipase (raised)
  • Imaging
    • Abdo US
    • Contrast-enhanced CT
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13
Q

What other factors can cause a raised serum amylase?

A
  • Bowel perforation
  • Ectopic pregnancy
  • Mesenteric ischaemia
  • DKA
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14
Q

Describe risk scoring for Acute pancreatitis?

A
  • Modified Glasgow Criteria
    • Assesses severity within 48hours of admission
  • PANCREAS
    • pO2<8kPa
    • Age>55
    • Neutrophils: WCC>15x109/L
    • Calcium <2mmol/L
    • Renal function: Urea >16mmol/L
    • Enzymes: LDH>600U/L
    • Albumin <32g/L
    • Sugar: glucose >10mmol/L
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15
Q

Describe the use of abdominal ultrasound for acute pancreatitis?

A
  • If underlying cause is unknown
  • Identifies gallstones through dilation of bile ducts
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16
Q

Describe the use of AXR in diagnosing acute pancreatitis?

A
  • Not routinely performed
  • Can show sentinal loop sign
    • Dilated proximal bowel loop adjacent to pancreas
    • Secondary to localised inflammation
17
Q

Describe the use of a contrast-enhanced CT scan in the diagnosis of acute pancreatitis?

A
  • Performed within 48hrs of presentation if bloods are inconclusive
  • Can show areas of pancreatic oedema and necrosis
18
Q

Describe the managment of Acute pancreatitis?

A
  • Most people settle with supportive treatments
    • Oxygen, fluids
    • NG tube if vomiting, opioid analgesia
  • Treat underlying cause
    • Gallstones
      • ERCP, sphincterotomy
19
Q

What are the systemic complications of Acute pancreatitis?

A
  • Disseminated intravascular coagulation (DIC)
  • ARDS
  • Hypocalcaemia
  • Hyperglycaemia
20
Q

What are the local complications of Acute pancreatitis?

A
  • Pancreatic necrosis
  • Pancreatic pseudocyst
21
Q

Describe pancreatic necrosis as a complication of acute pancreatitis?

A
  • Suspect in patients with persistent systemic inflammation >7 days
  • Confirmed by CT scan
  • Fine needle aspiration of the necrosis if infection develops
22
Q

Describe a pancreatic pseudocyst as a complication of acute pancreatitis?

A
  • Collection of fluid containg enzymes, blood and necrotic tissue
  • Usually seen in the lesser sac
  • Best visualised using MRI
  • Treatment with surgical debridement or endoscopic drainage into stomach
23
Q

What are the two different functions of the pancreas?

A
  • Endocrine
  • Exocrine
24
Q

Describe the exocrine function of the pancreas?

A
  • Digestion of fats, protein asnd carbohydrate
  • 1L of alkaline enzymne-rich fluid is produced every day
  • Trypsin, lipase and amylase
25
Q

Describe the endocrine function of the pancreas?

A
  • Islets of langerhans
    • α cells - glucagon
    • β cells - insulin
    • D cells - somatostatin
    • PP cells - pancreatic polypeptide
26
Q

What is ileus?

A
  • Lack of movement of somewhere in the intestine
  • Leads to build up and potential blockage
27
Q

Describe the symptomatic stratification of mild acute pancreatitis?

A
  • No organ failure
  • No local or systemic complications
28
Q

Describe the symptomatic stratification of moderately severe acute pancreatitis?

A
  • Organ failure which resolves wtihin 48 hours and/or
  • Local or systemic complications without persistent organ failure
29
Q

Describe the symptomatic stratification of severe acute pancreatitis?

A
  • Persistent organ failure > 48 hours
    • Single organ failure
    • Multiple organ failure
30
Q

Label the pancreas

A
31
Q

Describe the blood supply of the pancreas?

A
  • Pancreatic branches of the splenic artery
  • Head is additionally supplied by the superior and inferior pancreaticoduodenal arteries
  • Superior pancreaticoduodenal is from coeliac trunk
  • Inferior pancreaticoduodenal is from the superior mesenteric arteries
32
Q

Describe the venous drainage of the pancreas?

A
  • Head of pancreas
    • Superior mesenteric branches of the hepatic portal vein
  • Rest of the pancreas
    • Pancreatic veins to splenic veins
33
Q

What regions of the abdomen does the pancreas lie in?

A

Epigastric and left hypochondrium

34
Q

What is the only part of the pancreas that is intraperitoneal?

A

Tail

Y4: Acute surgery (9 decks)

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