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Acute pancreatitis (Aetiology
(I GET SMASHED) (Iatrogenic
ERCP
Surgery,…
Acute pancreatitis
Aetiology
(I GET SMASHED)
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Drugs
Alcohol
Steroids
Diuretics (furosemide, thiazides)
Immunosuppressants (azathioprine, 6-MP)
AEDs (valproate)
Abx (tetracycline)
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Infection
Viral - mumps, Cocksackie B
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Diagnosis
Examination
General - tachycardia, fever
Abdo - jaundice, guarding, rigidity, tenderness,
Cullen's and Grey-Turner signs (late; severe)
Investigations
Bloods
FBC (infection, anaemia), CRP (raised), U+E, LFTs, Ca (raised)
Amylase (raised), serum lipase (more specific)
ABG (acid base)
Imaging
Erect CXR (perforation), AXR
Abdo USS (gallstones)
Contrast CT/MRI abdo (confirm diagnosis, assess severity)
MRCP (check for other stones)
ERCP (exploratory if deterioration)
Obs
Temp, HR, RR, PaO2, WCC
Check for SIRS (MOF)
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Pathophysiology
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Alcohol
Sphincter of Oddi spasm
Reduced bicarb secretion, early enzyme activation
Overall
Increased calcium activates proteases which damage cells
Inflammation, oedema, necrosis and tissue damage
Fluid shifts can cause shock and hypovolemia
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Natural
history
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Severe pancreatitis
Rare
Haemorrhage and necrosis of the pancreas
May lead to infection of the pancreas and formation
of abscesses/pseudocysts
Systemic involvement i.e. MOF
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Complications
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Late
Pancreas necrosis,
abscess, pseudocyst
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Definition
Inflammation of the pancreas, usually
on background of a normal pancreas,
returns to normal state afterwards