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Acute pancreatitis - Coggle Diagram
Acute pancreatitis
Definition
Acute inflammation of the pancreas, sometimes associated with multiple organ failure - 10% cases are idiopathic
Epidemiology
Affects men more than women// 56 per 100,000
Risk factors
Excessive alcohol intake, smoking, gallstones, pregnancy
Types
Mile acute pancreatitis
absence of organ failure or systemic complications
Moderately severe pancreatitis
local complications and or transient organ failure - resolves within 48 hours
severe acute pancreatitis
persistent multi organ failure, resolves within 48 hours
Diagnosis and investigations
Diagnosis
Usually clinical diagnosis based on history. Confirmed using ECRP
Investigations
Blood test
high amylase and lipase, high WBC but normal FBC, high CRP, normal LFTs, O2 and glucose
US
To look for any gall stones
ERCP
CT scan
Show inflammation, any necrosis, pseudocyts, retro peritoneal fluid
Severity score systems
Glasgow
Severity of pancreatic disease (measurements are based using acronym pancreas - PO2, age (>55), neutrophils, renal function, enzymes, albumin, sugar) - 3 or more = severe
SIRS
systemic inflammatory response syndrome - two or more of: temperature (38-36), HR>90, RR>20/PCO2 <32mmHg, WBC >12000 cells/mm3
Management
Determine aetiology 2. manage symptoms (analgesia - IV) 3. reduce pancreatic stimuli 4. correct hypovolemia/electrolyte imbalance 5. monitor urine output
Pancreatitis caused by alcohol
Symptom management and benzodiazepines for alcohol withdrawl
Pancreatitis caused by gallstones
Urgent ECRP
Symptoms
Severe epigastric abdominal pain (gradual or sudden). Typically radiating to the back. May be relieved when sitting forward. Nausea and vomitting
Signs
Tachycardia, fever, jaundice, palpable mass (malignant), epigastric TTP, shock (septic, hypovalemic)
Cullens, Grey turners
Aetiology (I GET SMASHED)
Idiopathic, gall stones, ethanol, trauma, steroids, mumps or malignancy, autoimmune, scorpion, hypertriglercidemia, ERCP, drugs (ACEi, diuretics)
Complications
pancreatic cyst, haemorrhage, ARDS, disseminated intravascular coagulation