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

• presents as an acute abdomen

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

• Gallstones
• Alcohol
• Infections
  • mumps
  • typhoid
  • coxsacchie B virus
• Pancreatic tumours
• Drugs
  • azathioprine
  • oestrogens
  • corticosteroids
• Iatrogenic
• Hyperlipidaemias
• Trauma
• Scorpion bites
• Cardiac surgery
• Idiopathic
• Regurgitation of infected bile
• Vascular
• Duodenopancreatic reflux

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

• Metabolic
  • malnutrition
  • Hypocalcaemia
  • hypoglycaemia
• Haematological
  • disseminated intravascular coagulation
• Renal
  • acute renal failure
• Cardiovascular
  • shock
• Respiratory
  • Adult respiratory distress syndrome

Prognosis

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

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