Acute Pancreatitis

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Ransons Criteria
Glasgow Score

  • acute inflammation of pancreas may extend into surround tissues

Aetiology

  • Auto-digestion by pancreatic enzymes

Presentation

Symptoms

  • sudden onset pain
  • central, epigastric or hypochodondrial pain
    • eased on sitting forward
    • radiation through to back
  • lots of vomiting

Signs

  • may be none
  • tender / rigid abdomen
  • shock
  • fever
  • tachycardia
  • hypoxia / dyspnoea
  • ileus
  • Cullens
    • umbilical ecchymoses
  • Grey-Turners
    • ecchymoses in flanks

Causes

  • 80% accounted for by gallstones and alcoholism
  • GET SMASHED
    • Gallstones
    • ERCP
    • Tumour
    • Surgery
    • Mumps
    • Alcohol
    • Scorpion venom
    • Hyperlipidaemia
    • Estrogens
    • Drugs

Acute

Investigations

  • Serum amylase
    • 3-4x normal
    • can be greater than 1000 U/ml
  • USS
    • complications
    • gallstones
  • CT
    • complications
  • ERCP

Daily monitoring of

  • FBC
  • U&Es
  • calcium
  • amylase
  • blood gases
  • LFTs

Markers of a severe attack / poor prognosis

Ranson's Criteria

Glasgow Criteria

  • PaO2 < 8kPa
  • Urea > 16
  • Ca++ <2.0
  • LDH >600
  • Glucose >10
  • Albumin <30
  • WBC >15
  • ALT >200 U/L

APACHE-2

CRP >100

Treatment

Mild

  • IV fluids
  • analgesia
    • non-opioid
  • NG tube

Severe

  • O2
  • Ca++
  • ABGs
  • Analgesia - pethidine
  • consider
    • ITU / ventilation
    • inotropes
    • haemofiltration
  • Surgery
    • if diagnosis unclear
    • debridement
    • drainage
    • sphincterotomy
    • possible cholecystectomy
      • 6 weeks later if severe attack
      • before discharge if attack mild

Complications

Pancreatic

  • Acute fluid collection
  • Necrosis
  • Pseudocyst
  • Abscess
  • Ascites

Intestinal

  • paralytic ileus
  • GI haemorrhage

Hepatobiliary

  • Jaundice
  • Obstruction of common bile duct
  • Portal vein thrombosis

Systemic

Prognosis

  • 1% mortality in mild cases
  • 50-100% mortality in severe cases
 

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