GI - Acute Pancreatitis Flashcards Preview

Year 3- Surgery > GI - Acute Pancreatitis > Flashcards

Flashcards in GI - Acute Pancreatitis Deck (11)
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1
Q

Acute pancreatitis: pathophysiology

A
  • pancreatic enzymes released and activated in vicious circle —> multi stage process
    1. Oedema + fluid shift + vomiting = hypovolaemia
    2. Vessel auto-digestion —> Retroperitoneal haemorrhage (Cullen’s + Grey Turner signs)
    3. Inflammation —> pancreatic necrosis
    4. Super-added infection: 50% of pts have necrosis
2
Q

Acute pancreatitis: aetiology

A
  • Idiopathic
  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Mumps
  • Autoimmune
  • Scorpion bites
  • Hyperlipidaemia, hyperthermia
  • ERCP
  • Drugs: thiazides, azathiprine
3
Q

Acute pancreatitis: symptoms

A
  • Severe epigastric pain radiating to back (may be relieved by sitting forward)
  • vomiting
4
Q

Acute pancreatitis: signs

A
  • raised HR and RR
  • fever
  • hypovolaemia leading to shock
  • epigastric tenderness
  • jaundice
  • ileus (absent bowel sounds)
  • Ecchymoses: Grey Turner (flank) and Cullens (peri-umbilical, tracks up falciform)
5
Q

Acute pancreatitis: differential

A
  • Perforated DU
  • Mesenteric infarction
  • MI
6
Q

What is the scale and name of criteria

A

Glasgow Criteria (spell out pancreas)

  • PaO2 <8kPa
  • Age: >55years
  • Neutrophils: >15x10^9/L
  • Ca2+ (uncorrected): <2mM
  • Renal function: Urea >16mM
  • Enzymes: LDH>600iu/L and AST>200iu/L
  • Albumin: <32g/l
  • Sugar: >10mM
  • If scores on 1 (mild), 2 (mod) and 3 (severe)
7
Q

Acute pancreatitis: Ix - bloods and urine

A
  • FBC: raised WCC
  • U+E: dehydration and renal failure
  • LFT: cholestatic picture with raised AST and raised LDH
  • low calcium, high glucose
  • CRP: raised
  • ABG: low PaO2 suggests ARDS
  • Urine: glucose, amylase, low urobilinogen
8
Q

Acute pancreatitis: Ix - imaging

A
  • CXR: ARDS and exclude perf DU
  • AXR: pancreatic calcification
  • US: gallstones and dilated ducts + inflammation
9
Q

Acute pancreatitis: Mx - conservative

A
  • Manage at appropriate level (may need ITU)
  • Daily bloods, hourly obs/input-output monitoring
  • Analgesia: morphine or pethidine
  • Antibiotics: used if suspicion of infection (penems preferred)
  • O2 therapy (for ARDS Mx), sliding scale (rising glucose), Ca2+ (ca falls)
10
Q

Acute pancreatitis: Mx - interventional

A
  • Main option is ERCP if pancreatitis is associated with dilated ducts secondary to gallstones (do US first to prove this)
  • Rx: ERCP + sphincterotomy
11
Q

Acute pancreatitis: Mx -surgical (indications and options)

A

Indications:

  • Infected pancreatic necrosis
  • Pseudocyst or abscess
  • unsure of Dx

Options

  • Laparotomy + necrosectemy (panic debridement)
  • Laparotomy + peritoneal lavage
  • Laparostomy: abdomen left open with sterile packs in ITU

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