Pancreaatobiliary emergencies: acute pancreatitis Flashcards Preview

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Flashcards in Pancreaatobiliary emergencies: acute pancreatitis Deck (37):
1

What is the diagnosis of acute pancreatitis based on

The characteristic abdominal pain and nausea combined with elevated serum levels of pancreatic enzymes

2

What must be given immediately in acute pancreatitis

Fluid resuscitation

3

What has caused an increase in emergencies recently

The increase in alcohol consumption
The better diagnostic capability

4

What is the mortality rate in patients with acute pancreatitis

5%

5

What does the pathological process involve in acute pancreatitis

Inflammation
oedema
necrosis of pancreatic tissue

6

What is the mneumonic for the causes of acute pancreatitis

Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Spider bites/ scorpion bites
Hypertriglyceridaemia, hypercalcaecmia
ERCP
Drugs

7

What might cause premature activation of pancreatic enzymes

Obstruction by protein plugs

8

What is pancreas divisum

Where there is failure of the dorsal and ventral ducts to fuse in the embryo so that most of the pancreatic juice flows through the minor pancreatic duct and papilla

9

What happens when the pancreas becomes inflamed

Activation of pancreatic enzymes within the gland itself

10

What do the pancreatic enzymes do

Damage tissue
activating complement and the inflammatory cascade and produce cytokines

11

What 3 things can occur as a result of a systemic inflammatory response

Respiratory distress syndrome
Cardiovascular failure
renal failure

12

What is the main result of acute pancreatitis

A chemical burn - activated enzymes and cytokines enter the peritoneal cavity resulting in capillary leakage of pancreatic fluid

13

What are pseudocysts

Collections of pancreatic fluid and tissue debris formed around the pancreas surrounded by a fibrous lined capsule (not epithelial)

14

What are 3 metabolic complications of pancreatitis

Hypocalcaemia
Hypomagnesaemia
hyperglycaemia

15

What might become infected in pancreatitis

The pancreatic pseudocysts of the necrotic tissue by enteric bacteria

16

In what region is pancreatic pain found

Epigastric

17

Where does pancreatic pain radiate to

The back (50% of patients)

18

What might reduce the pain

Sitting up and leaning forwar

19

What might accentuate the pain

Coughing
Vigorous movement
Deep breathing

20

What are 2 other common presentations

Nausea and vomiting

21

What might be heard on a respiratory examination of a patient with pancreatitis

Basal crackles consistent with atalectasis

22

What is Grey- Turner's sign

Blue-grey discolouration of the flanks due to exudation of fluid sustained by pancreatic necrosis into the subcutaneous tissue

23

What is the Cullen's sign

Discolouration in the periumbilical area

24

What might the bowel sounds be liek in pancreatitis

Hypoactive

25

What might reduce the pain

Sitting up and leaning forward

26

What might the bowel sounds be like in pancreatitis

Hypoactive

27

How is the severity of acute pancreatitis defined

The presence or absence of organ failure, local complications or both

28

What is the scoring system used in pancreatitis

Ranson criteria

29

When is the Ranson criteria completed

48 h after onset of the episode

30

What are some clinical findings that indicate severe disease

Thirst
poor urine output
pregressive tachycardia
tachypnoea
hypoxaemia
agitation
confusion
rising haematocrit level
lack of improvement in symptoms

31

What is the most widely available test for pancreatitis

Serum amylase
Lipase

32

What should all patients have following a thorough history and physical examination

Serum amylase (and lipase if available)
FBC
U&E
Coagulation screening
LFT
Serum alctate
Calcium, magnesium
Glucose
ABG
Biliary ultrasonography

33

What are some of the follow up investigations

Fasting plasma lipids and calcium
repeat biliary ultrasonography

34

What must be excluded from the differential diagnosis in recurrent idiopathic acute pancreatitis

Pancreatic cancer
microlithiasis
chronic pancreatitis
pancreas divisum

35

What analgesia should be given

Opiate

36

What opiate should be avoided and why

Morphine - it might exacerbate pancreatitis by increasing sphincter of Oddi tone

37

What nutritional support should be the goal for all patients with acute pancreatitis

Enteral