Pancreatitis Flashcards
(33 cards)
What is acute pancreatitis and what would you see in a CT scan for acute pancreatitis
Rapid onset inflammation of the pancreas
CT scan- pancreas becomes muddy *as seen on diagram *. Normally pancreas is smooth
What is the definition of chronic pancreatitis and what are the signs you’d see on a CT scan for chronic pancreatitis
Long stands inflammation of the pancreas
CT scan- would see calcium (white spots) deposit on head of pancreas
Mention all the aetiology of the acute pancreatitis.
Which 3 are most common and which is least common
Acronym: GETSMASHED
3 most common are: gallstones, ethanol and trauma
Least common: Trinidad scorpion bite
Describe the pathogenesis of acute pancreatitis WHEN GALLSTONES is the aetiology
Gallstones causes reflux of bile from CBD into Main pancreatic duct.
This increases pressure in MPD. Hence increased permeability of pancreatic duct epithelium
Acinar cells enzymes (already in MPD) diffuse into periductal interstitial tissues
Pancreatic enzymes activated extracellularly and cause damage- trypsin activated
Describe the pathogenesis of acute pancreatitis when alcohol is the aetiological agent
Alcohol precipitates proteins in duct which can lead to increase in upstream pressure.
Hence acinar cells diffuse into periductal interstitial tissue and cause damage
How can pancreatic enzymes be activated intracellularly - another form of pathogenesis
Proenzymes and lysosomal proteases incorporated into the same vesicle
This activates trypsin
What are the potential downstream effects of extracellular or intracellular trypsin activation
DRAW DIAGRAM
What are the 3 common named type of acute pancreatitis? What can cause them? Why isn’t it ideal to call them these names?
Oedematous pancreatitis
Hameorrhagic pancreatitis - caused by arroding of blood vessels
Necrotic pancreatitis - caused by infection which can lead to infective necrosis. Bacteria produce gas in pancreas.
not ideal: very hard to distinguish on scans which is which
What are the symptoms of Avute pancreatitis
- Epigastric pain radiating to the back. This is often eased by sitting forward
- N&V - vomiting
- fevers
What are the signs of acute pancreatitis
- Haemodynamic instability - tachycardia and hypotensive
- Peritonism in upper abdomen / or any part of abdomen
- Grey- Tuner’s sign - bruising in flanks
- Cullen’s sign- bruising around umbilicus
What 2 signs of acute pancreatitis are definitely seen in haemorrghic pancreatitis
Grey turner sign
Cullen’s sign
What are the potential differential diagnoses for the causes of acute pancreatitis
Gallstone disease and associated complications like biliary colic and acute cholecyctitis
Peptic ulcer disease/perforation
leaking/ruptured abdominal aortic aneurysm
What are the investigations you’d perform to hone down differential diagnoses. What will you look for for each investigation?
- Blood test- look for elevated amylase or lipase
- Erect chest x-ray
- Abdominal x ray- look for sentinel loop or gallstones
- USS (Ultrasound)- look for GSs as cause of pancreatitis
- CT abdomen- do this only if pt isn’t settling with conservative management and 48-72 hrs after symptoms onset
- MRCP- only if GS pancreatitis is suspected with abnormal liver function tests (CBD stone)
- ERCP - you HAVE TO BE SURE IT’S CBD Gallstones
What is the criterial for measuring severity of acute pancreatitis ? List it out and what result suggest severe pancreatitis
Modified Glasgow criteria
a score of 3 or above within 48hrs of onset suggest severe pancreatis
What molecule in the blood can be used as an independent predictor of severity of acute pancreatitis
CRP
above 200 CRP suggest severe pancreatitis
What are the systemic complications of Acute pancreatitis
- Hypocalcaemia; as a result of saponification
- Hyperglycaemia (diabetes if beta cells damage is significant)
- SIRS- Systemic inflammatory Response Syndrome
- ARF- Acute Renal Failure
- ARDS- Adult Respiratory Distress Syndrome
- DIC- Disseminated Intravascular Coagulation
- Multi Organ failure and death
What are the local complications of acute pancreatitis
- Pancreatic necrosis with or without infection
- Pancreatic abscess
- Pancreatic pseudo cyst
- Haemorrhage- due to bleeding from arroded vessels
- Thrombosis of: Splenic vein (lowest frequency), SMV, portal vein(highest frequency)
- Chronic pancreatitis
A local complication of acute pancreatitis is haemorrhage
describe the outcome for haemorrhaging of small and large vessels
Small vessels- causes haemorrhaging pancreatitis, hence Cullen’s or grey-Turner’s signs seen
Large vessels- (like splenic artery) can be life threaintie unless it forms a pseudoaneurysm
Thrombosis is one of the local complications of acute pancreatitis. Describe what the outcome could be?
Formation of ascites
small bowel venous congestion/ischaemia
Outline the process of saponification
Lipases converts lipids to FFAs
FFAs chelate Calcium salts
this decreases Ca2+ serum levels
What complication of acute pancreatic gives the only indication for surgical intervention? Also what does surgical intervention entail
Infected pancreatic necrosis- high mortality rate if dead infected tissue isn’t debrided
Surgery involves necrosectomy
What is a complication of infected pancreatic necrosis . Describe what it is and when it presents
Formation of pancreatic abscess
- this is a collection of pus form pancreatic tissue necrosis and infection
- becomes lined by granulation tissue
- presents 2-4 weeks after attack of pancreatitis
How do you manage pancreatic abscess?
Antibiotics and drainage
drainage could entail
- percutanoeus - CT guidance .
- Surgical drainage - VERY HIGH MORTALITY RATE
*diagram shows percutanoues CT drainage*
What is pancreatic pseudocyts and when does it present
Peri-pancreatic fluid collection
increased pancreatic enzymes within a fibrous capsule. NO EPTIHELIAL LINING
it presents more than 6 weeks after pancreatitis
