Acute Pancreatitis Flashcards Preview

Liver > Acute Pancreatitis > Flashcards

Flashcards in Acute Pancreatitis Deck (27)
Loading flashcards...
1
Q

What is the acronym for remembering the causes of acute pancreatitis?

A

I GET SMASHED

2
Q

What does I GET SMASHED stand for?

A

Idiopathic, gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion venom, hyperlipidaemia/hypercalcaemia/hypothermia, ERCP, drugs (diuretics/immunosuppressants)

3
Q

What percentage of cases are caused by gallstones and alcohol?

A

80%

4
Q

What occurs in acute pancreatitis?

A

Insult to the pancreas causes pancreatic enzymes to leak and autodigest the pancreas parenchyma causing damage and self perpetuating inflammation

5
Q

What response may be activated by acute pancreatitis?

A

The SIRS

6
Q

What are the two most severe complications of acute pancreatitis?

A

Haemorrhagic pancreatic necrosis

Infected pancreatic necrosis

7
Q

What percentage of cases are mild?

A

80%

8
Q

What are the symptoms of acute pancreatitis?

A

Generalised or sudden severe epigastric pain/central abdominal pain, pain radiates to the back, pain relieved by sitting forward, nausea and vomiting

9
Q

What are the signs of acute pancreatitis?

A

Tachycardia, shock, fever, ileus, guarding, left flank tenderness, Cullens sign, grey-turners sign

10
Q

What is Cullens sign?

A

Peri-umbilical discolouration

11
Q

What is grey-turners sign and what causes it?

A

Bruising on the left flank due to blood vessel autodigestion and haemorrhage

12
Q

What investigations would you do?

A

Amylase levels, serum lipase, LFTs, USS, AXR, CXR, CT, CRP

13
Q

At what level is amylase diagnostic?

A

When it is above 3 times the normal limit

14
Q

Why might amylase be normal?

A

As amylase levels fall within 24-48hrs

15
Q

What co-morbidity may increase the amylase levels?

A

Renal failure as this causes means less amylase is excreted

16
Q

What other conditions may raise amylase?

A

Cholecystitis, peptic ulcer, pregnancy, mesenteric infarction, rhabdomyolysis

17
Q

Why is serum lipase a better test?

A

It is both more sensitive and more specific

18
Q

What might an AXR show?

A

Loop of proximal jejunum on causes by local ileus known as a sentinel loop

19
Q

What might the CT show?

A

The extent of necrosis of the pancreas and the areas affected

20
Q

What are the early complications?

A

Hypovolemic shock, hypocalceamia, diabetes, DIC, respiratory failure, renal failure

21
Q

Late complications include? (After 1 week)

A

Pancreatic necrosis, pseudocyst with fever, abscesses, bleeding, thrombosis in splenic/gastroduodenal arteries causing bowel necrosis, fistula, recurrent oedematous pancreatitis

22
Q

What is the management? In mild patient

A

ABC assessment, oxygen, Severity assessment, nil by mouth, LOTS of IV saline (renal failure), urinary catheter, morphine, hourly monitoring, ITU if worsening

23
Q

If the patient is still worsening, what management would you do?

A

Antibiotics if >30% necrosis eg IV imipenem, pareneternal nutrition and necrosectomy, ERCP if there is progressive jaundice

24
Q

What differential would you consider?

A

Any acute abdomen but especially mesenteric infarction/perforated peptic ulcer

25
Q

What is the associated mortality of acute pancreatitis?

A

12%

26
Q

What does the PANCRES severity assessment stand corrected?

A

PaO2 (less than 8kPa), age (>55), neutrophillia, calcium low (most prognostic of death), renal function (urea above 16 (norm=1.8-7.1)), enzymes (raised LDH and AST), blood glucose above 10

27
Q

How many criteria must be met to be classed as severe?

A

3