Pancreatitis Flashcards
(37 cards)
What is the epidemiology of pancreatitis ?
It is acute inflammation of the pancreas leading to the spillage of pancreatic enzymes and cytokines. It accounts for 3% abdominal pain related hospital admission. It can occur at any age with an overall mortality of 10%.
What is the acronym I GET SMASHED stands for ?
It stands for the etiologies of pancreatitis.
I= Ideopathic
G= Gallstone
E= Ethnole
T= Trauma
S= Steroids
M= Mumps
A= Autoimmune
S= Scorpion sting
H= Hypertriglyceridaemia
E= ERCP
D= Drugs
What are the elements of history in acute pancreatitis ?
– Family history of blood disorders
– Recent foreign travel
– Recent changes in medications
– Surgery or recent anaesthesia
– History of gallstones
– Alcohol intake
– Fever, pain, rigors (cholangitis)
– Weight loss
– Known history of peri-ampullary tumors
– Any change to stool/urine colour
What is the pathogenesis of acute pancreatitis ?
Inflammation of the pancreas cause the pancreatic enzymes mediated destruction of pancreatic paranychma and often SIRS due to cytokine storm.
What is the pathology of mild pancreatitis ?
interstitial oedema with little or no necrosis.
What is the pathology of severe pancreatitis ?
extensive necrosis , thrombosis and
intraparenchymal haemorrhage.
What is the pathophysiology of chronic pancreatitis ?
Pancreatitc fibrosis with loss of both endocrine/exocrine function.
What are the symptoms of acute pancreatitis ?
Sudden onset of epigastric pain which radiates to the back and relived by sitting forward as well as N/V.
What are the severity dependent signs of acute pancreatitis ?
– Dehydration
– Epigastric guarding
– Tachycardia, tachypnoea,
mild pyrexia
– If biliary obstruction: jaundice
– Cullen’s sign
– Grey Turner’s sign
– renal, pulmonary dysfunction and DIC.
What is the Atlanta classification of mild pancreatitis ?
- No organ failure
- No local or systemic
complications
What is the Atlanta classification of moderate pancreatitis ?
- Transient organ failure
(<48hrs) - Local or systemic
complications
What is the Atlanta classification of severe pancreatitis ?
- Persistent organ failure
(>48hrs)
What are the elements of modified IMRE score ?
– P: PaO2 <8kPa (arterial)
– A: Age >55
– N: Neutrophilia (WCC >15)
– C: Calcium <2mmol/L
– R: Renal (urea >16)
– E: Enzymes (LDH >600, AST
>200)
– A: Albumin (32g/L)
– S: Sugar (blood glucose >10)
What is the IMRE score for severe pancreatitis and its management ?
> 3 and the management is ICU/HDU care with hourly monitoring of vitals.
What is the Amylase profile in acute vs chronic pancreatitis ?
In acute it is 3X the upper limit of normal and it chronic it can be normal.
What are the bloods in pancreatitis ?
FBC, CRP, LFT’ s, U&E, Calcium, Albumin, glucose
What are the workups to rule out complications of pancreatitis ?
- ABG
*CXR (Look for free air under diaphragm) - Ultrasound Abdomen
- CT pancreas (to judge severity/complications)
What are the prophylaxis in acute pancreatitis ?
– Antithrombotic prophylaxis
– Stress ulcer prophylaxis
How is the feeding management in pancreatitis ?
Initially NPO, reintroduce feeding when possible via NGT, NJT,
or TPN.
What is the general management of acute pancreatitis ?
Supportive management with acute abdomen protocol.
What are the complications of acute pancreatitis ?
- Pseudocyst formation
- Pancreatic abscess
- Necrotising pancreatitis
- Intra abdominal sepsis
- Necrosis of transverse colon
- Pancreatic haemorrhage
/pseudoaneurysm GDA - Chronic pancreatitis
- Systemic
(ARDS/effusions/ATN) - Metabolic (hyperglycaemia,
hypocalcaemia) - Mortality
What are the 2 phases of necrotising pancreatitis ?
- SIRS in the first 1 to 2 weeks.
- 2+ weeks Sepsis.
What accounts for 80% of mortality with acute pancreatitis ?
Infected pancreatic
necrosis.
What are the measures to prevent acute pancreatitis ?
- Removal of gallstones as it is the cause of 30% of recurrence.
- Alcohol withdrawal.
- Seek and treat ↑Ca,↑lipids.
