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Flashcards in FN: Acute Pancreatitis Deck (23):
1

Pathophysiology

Pancreatic enzymes released and activated in vicous circle --> multi-stage process

2

Pathophysiology linked to presentation

1. OEdema + fluid shift + vomiting--> hypovolamaemic shock while enzymes --> autodigestion and fat necrosis
2. Vessel autodigestion --> retroperitoneal haemorrhage
3. Inflammation - pancreatic necrosis
4. Super-added infection: 50% of pts/ w/ necrosis

3

Epi

1% of surgical admission
2. 4th and 5th decades
10% mortality

4

Aetiology

IGET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Microbiology: infection
Autoimmune
Scorpion bite
Hyperlipidaemia
ERCP
Drugs:thiazides, azathioprine

5

symptoms

Severe epigastric pain - radiating to the back -May be relived by sitting forward
Vomiting

6

Signs

Raised HR, Raised RR
Fever
Hypovolaemia - shock
Epigastric tenderness
Jaundice
Ileus - absent bowel sounds
Ecchymoses
1. Grey turners: flank
Cullens periumbilical (tracks up falciform)

7

differential

Perforated DU
Mesenteric infarction
MI

8

Classifying criteria

Modified glasgow criteria
Ranson criteria

9

Modified Glasgow Criteria

Valid for EtOH and Gallstones
Assess severity and predict mortality

10

Ransons criteria

are only applicable to EtOH and can only be fully applied after 48hrs

11

Investigations

Bloods
Urine
Imaging

12

Bloods show

1. Raised WCC
2. Raised amylase and raised serum lipase - returns to nromal by 5-7days
3. U+E: dehydration and renal failure
4. LFTs: cholestatic picture, raised AST, raised LDH
Calciu: reduced
Glucose reduced
CRP: monitor progress >150 after 48hrs = severe
ABG: reduced oxygen sggest ARDS

13

Urine show

Glucose,
Raised cBR
Reduced urobilinogen

14

Imaging

CXR:ARDS, exlcude perfer DU
AXR: sentinel loop, pancreatic calcification
US: Gallstones and dilated ducts
Contrast CT: balthazar Severity Score

15

conservative Management

Manage @ apprpriate levle: e.g TU if severe
Constant reassessment is key
1. Hrly TPR, UO
Dakly FBC, U+E, Calciu, glucose amylase ABG

16

Fluid resus

Aggressive fluid resusL Keep UO >30 ml
Catheric ! CVP

17

Pancreatitc rest

NBM
NGT if vomiting

18

Conservative management

Fluid reses
Pancreatic rest
Analgesia
Antibiotics

19

Antibiotics

Not routinely given if mild
Used if suspicion of infection of before ERCP
Penems often used: meropenem imipenem

20

Management complications

ARDS: Oxygen therapy or ventilation
Raised glucose: insulin sliding scale
Raised or reduced Calcium
EtOH withdrawal: chlordiazepoxide

21

Interventional Management

If pancreatitis with dilated ducts secondary to gallstones
ERCP + shpincterotomy - reduced surgical complications

22

Surgical management indications

Infected pancreatic necrosis
Psuedocyst or abscess
Unsure diagnosis

23

Operations available

Laparotomy + necrosectomy (pancreatic debridement)
Laparotomy + peritoneal lavage
Laparostomy: abdomen left open with sterile packs in ITU

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