acute inflammatory process that may involve surrounding tissue and organs w/ 5% overall mortality & 20% will have necrosis
acute pancreatitis
two most common causes of acute pancreatitis
alcohol and gallstones
after sentineal case of acute case, loss of endocrine & exocrine function
irreversible progressive fibrosis & calcification
chronic pancreatitis
what is this condition?
- severe, acute upper abd. pain w/ possible radiation
- better w/ sitting up or bending forward
- N/V
if they have severe case what symptom will you likely see?
acute pancreatitis
dyspnea can happen w/ severe pancreatitis
describe difference in pain presentation when acute pancreatitis is d/t gallstones vs other causes (2)
if d/t gallstones, pain is rapid- peaks w/in 10-20mins and well localized
if d/t other causes, it’d be poorly localized, less abrupt onset
condition when you have 2 smaller pancreatic ducts instead of 1 big one. since they are smaller, they are more likely to get things stuck in them
pancreas divisum (an obstructive cause of acute pancreatitis)
4 obstructive causes of acute pancreatitis
gallstones
pancreas divisum
tumors
post ERCP
2 toxic causes of acute pancreatitis
alcohol
meds– aminosalicylates, flagyl, sulfa, pentamidine, azathioprine
BADSHIT is acronym for etiologies of acute pancreatitis. What does it stand up?
- Biliary
- Alcohol
- Drugs– lasix, antiHIV, HCTz
- Surgery
- Hereditary, Hyperlipid states
- Iatrogenic (post ERCP), idiopathic, infection
- Tumor, trauma, trinidad scorpion bite
how does smoking affect pancreas? (2)
increases risk of both types of pancreatitis
increases risk of pancreas adenocarcinoma
what do you need to diagnose pancreatitis?
clinical picture + amylase/lipase levels OR US/CT
of all the labs you can get to work up pancreatitis, which one looks for necrotic/dead tissue?
lactate
between amylase & lipase, which stays elevated for longer & is more sensitive?
lipase
amylase can be WNL in what two scenarios?
hypertrig. & alcoholics
relationship btwn amylase/lipase levels & severity of dz
does NOT correlate
differentiate mild v. moderate v. severe acute pancreatitis
- mild: no organ failure or complications
- moderate: transient (under 48hrs) organ compromise, local complication
- severe: persistent (over 48hrs) organ failure
majority are mild
general tx of acute pancreatitis (4)
IV lactated ringers 250-400 cc/hr (careful in HF or dialysis)
enteral feeding/NPO
ERCP or cholecystectomy
pain management
which treatment does this
decreased infectious complicatins
decreased hospital stay & mortality
less organ failure
enteral feeding
if they have a gallstone or tumor & a stent is needed, what tx can you do?
ERCP or cholecystectomy
2 labs to monitor during IV fluids inorder to adjust it?
hematocrit– falls with RE-hydration
BUN– if too high, its sign that kidney is starting to fail
first 48 hrs very important
on admission (up to 5 points)
- over 55 yo
- leukocyte over 16K
- glucose over 200
- LDH over 350
- AST over 250
first 48 hrs
- HCT over 10%
- BUN over 5
- Ca++ under 8
- PaO2 under 60
- Base deficit over 4
- fluid sequestration over 6
Ranson’s criteria for acute pancreatitis
4 things that make up lactated ringer fluid
NaCl
Na Lactate
K+
Ca++
list two types of complications of acute pancreatitis
- hemorrhagic: cullens (dark umbilical region), gray turners (bruised flanks)
- pseudocyst from liquid getting stuck: N/V, ileus
- constant upper abdominal pain, worse w/ food; episodic or steady
- malabsortion– wt loss, steatorrhea, vitamin deficiency
- diabetes
sx of chronic pancreatitis
