Acute Pancreatitis

Causes: Remember the mneumonic I GET SMASHED

Epidemiology: happens after an acute injury. This acute injury can lead to necrosis or haemorrhage!

Definition: pancreatitis is the inflammation of the pancreas. This is due to a number of factors. It has specific clinical features. The pancreas is made up of exocrine cells (digestive enzymes --> common bile duct) and then the endocrine cells (secrete hormones)

Acute pancreatitis happens when there is no background of prior pancreatic problems. After the disease has been treated the pancreatic function can return to normal

Treatment- The level is determined by the APACHE II and Glasgow & Ranson scoring system

Diagnosis

Clinical Presentation

Pathophysiology

Endocrine cells: Alpha cells= glucagon

Endocrine cells: Beta cells= inculin

Endocrine cells: somatostatin. This stimulates gastric distension

Endocrine cells: enterochromaffin cells allow for serotonin production

Endocrine cells: PP cells these are pancreatic polypeptides (inhibit acinar enzyme secretion

T trauma

S Steroids

E Ethanol

M Mumps

G Gallstones

A Autoimmune

I Idiopathic

S Scorpion venom

H Hyperlipidaemia

Also pregnancy and neoplasm

E ERCP

D Drugs (NSAIDs, diuretics, ACE inhibitors)

This damage causes an activation of the pancreatic enzymes. This means that the pancreas is auto digested

In Gallstones this happens because there is an obstruction of enzyme-rich fluid out of the pancreas. There is early activation of trypsinogen

An acute attack on the pancreas. This means that the gland can undergo haemorrhage or necrosis

Alcohol-induced pancreatitis. Alcohol interferes withCa2+ homeostasis and means that there is a leakage of fluid into tissues causing oedema, inflammation and hypovolaemia (as liquid is stuck in gut, peritoneum and retroperitoneum) .This inflammation stimulates the activation of enzymes

Lipolytic enzymes cause fat necrosis that leads to skin discolouration (Grey Turner's sign) . The lipids also bind to Ca2+ ions meaning that hypocalciaemia can occur

Sitting forward will relieve the pain

Anorexia, nausea and vomiting are all symptoms

Central pain that radiates to the back

Shock symptoms: tachycardia, fever, jaundice, dehydration and hypotension

Abdominal guarding

Grey Turner's sign . Skin discolouration of the flank

Periumbilical ecchymosis. Cullen's sign

Ultrasound --> looks for galllstones

CT

Erect CXR to see if there is any gastroduodenal perforation

MRI

FBC. Raised serum amylase and Raised urine amylase. Raised serum lipase and also CRP will be raised

Use Glasgow and Ranson scoring system. Looks at age, neutrophils, calcium and blood glucose

APACHE II (Acute Physiology And Chronic Health Evalulation

IV antibiotics (metronidazole and cefuroxime)

IV fluids

Nil by mouth to decrease pancreatic stimulation

Analgesia (IM pethidine or IV morphine)

Complications

Tachypnoea

Pyrexia

Tachycardia greater than 90bpm

High WBC count