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