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20 Cards in this Set
- Front
- Back
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Hormones secreted by the pancreas and cells |
Glucagon alpha Insulin beta Somatostatin delta Pancreatic polypeptide pp Pancreastatin beta Grhelin epsilon Amylin beta |
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What is pancreatitis |
Acute inflammation of of the prior normal gland parenchyma which is usually reversible with raised pancreatic enzymes level in the blood and urine |
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Marseille classification of pancreatitis |
Acute Chronic Acute relapsing Chronic relapsing |
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Causes of pancreatitis |
Alcoholism Biliary tract disease-gallstones Tumors Trauma ERCP or after biliary surgery Autoimmune Hypercalcemia Hyperlipidemia Diabetes Viral infections(mumps, cocksackie) Biliary ascariasis, Clonarchis sinensis Infectious mononucleosis Mycoplasma pneumonia Pancreatic divisum Venom of Tityus trinitasis Drugs: INH, THIAZIDES, SEPTRAN, TETRACYCLINE, ESTROGEN, AZATHIOPRINE |
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What genes when mutated can cause pancreatitis |
PRSS1, SPINK 1 |
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What is initiating event in pancreatitis |
Injury to acinar cells by premature activation of intracellular zymogens |
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What are the local complications of acute pancreatitis |
Less than four weeks: acute peripancreatic fluid collection Acute necrotic collection with no defined wall Greater than 4 weeks: pseudocyst Walled of necrosis |
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What three organ systems are mostly affected by pancreatitis |
Renal Respiratory Cardiac |
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How do you diagnose pancreatitis |
History of sudden onset of sever constant abdominal pain that radiates to the back with risk factors(alcoholism or fat female fertile forty flatulence) Increased serum amylase and lipase 3times upper limit CT imaging if necessary to confirm diagnosis |
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Differentials of hyperamylasemia |
Parotitis Intestinal obstruction Peptic ulcer perforation Mesenteric ischemia Ruptured aortic aneurysm Renal failure Ectopic productions in cancers{breast, lungs, ovaries, multiple myeloma} |
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Grading of severity |
Mild-no organ failure, no systemic or local complications Moderate-transient organ failure and or local or systemic complications without persistent organ failure Severe-persistent organ failure can be single or multiple |
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What are the differential diagnosis of pancreatitis |
Esophagitis Perforated Peptic ulcer Ruptured aortic aneurysm Cholecystitis Diabetic ketoacidosis Ruptured Ectopic pregnancy Mesenteric ischemia Salpingitis Intestinal obstruction |
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Clinical features of acute pancreatitis |
Sudden onset of severe upper abdominal pain relieved when patient leans forward-Van Zant sign Vomiting, high fever, Tachypneoa, cyanosis Features of shock and dehydration Signs of peritonitis(Tenderness, rebound tenderness, guarding, rigidity, abdominal distention) Mild jaundice Oliguria, hypoxia and acidosis Ascites Paralytic ileus Hematemesis and melena due to duodenal erosion Pleural effusion, pulmonary edema, consolidation, ARDS Neuro derangements Hypovolemia Hypoalbuminemia Hypocalcemia Hylerglycemia Neutrophilia and thrombocytopenia Hypochloremic metabolic alkalosis Hyoertriglyceridemia Methemalbuminemia |
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What are the plain xray findings in acute pancreatitis |
Sentinel loop Colon cut off sign Air fluid level in duodenum Renal halo sign Obliteration of Psoas shadow Localised ground glass appearance |
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What are the three treatment modalities in acute pancreatitis |
Conservative Surgical Manage complications |
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Management of acute pancreatitis |
Resuscitation with IV fluids to replace sequestration and 3rd space losses sometimes blood products to replace in cases of massive hemorrhage Analgesia to provide pain relief Predict severity of pancreatitis Nasogastric aspirations Urinary catheterisation Nasojejunal tube placement for feeding Calcium gluconate to replace calcium losses IV omeprazole or ranitidine to prevent stress ulcers and erosive bleedings Total parenteral should be started immediately bowel sounds are heard to prevent infection and improve nutritional status Continue to monitor: vitals, calcium levels, uss examination |
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Complications of acute pancreatitis |
Local: Pancreatic phlegmon Pancreatic abscess Pancreatic pseudocyst Pancreatic ascites Fistula hemorrhage Bowel infarction Obstructive jaundice Splenic vein thrombosis Systemic: Psychosis Fat embolism stroke Alcohol withdrawal syndrome Atelactasis Pleural effusion Adult Respiratory distress syndrome Pneumonia Hypotension Hypovolemia Sudden cardiac death
Hemoconcentration DIC Peptic ulcer Erosive gastritis Portal or splenic vein thrombosis Variceal bleeds Oliguria Azotemia Renal artery or vein thrombosis Hyperglycemia Hypoglycemia Hypertriglyceridemia Encephalopathy Intra abdominal saponification Subcutaneous tissue necrosis HemoconcentrationDICPeptic ulcerErosive gastritisPortal or splenic vein thrombosisVariceal bleedsOliguriaAzotemiaRenal artery or vein thrombosisHyperglycemiaHypoglycemiaHypertriglyceridemiaEncephalopathyIntra abdominal saponificationSubcutaneous tissue necrosis HemoconcentrationDICPeptic ulcerErosive gastritisPortal or splenic vein thrombosisVariceal bleedsOliguriaAzotemiaRenal artery or vein thrombosisHyperglycemiaHypoglycemiaHypertriglyceridemiaEncephalopathyIntra abdominal saponificationSubcutaneous tissue necrosis Hyperglycemia Hypoglycemia Hypertriglyceridemia Encephalopathy Intra abdominal saponification Subcutaneous tissue necrosis |
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Clinical manifestations |
Unrelenting epigastric pain radiating to the back like a band worst on laying down, relieved by leaning forward may occur following heavy meal or an episode of acute alcoholism associated with nuasea, repeated vomiting and retching |
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Investigations |
Serum amylase times 3 ULN Serum lipase Contrast abdominal CT scan |
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Assessing severity use Ranson and Galsgow scoring system |
RANSON On admission: age>55, WBC>16,blood glucose>10 LDH>700 AST>250 GLASGOW Age>55,WBC>15, blood glucose>10, serum urea>16. PaO2 <8kpa |
