Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
10 Cards in this Set
- Front
- Back
|
Symptoms of Pancreatitis?
|
Epigastric pain (no guarding or rebound tenderness early as pancreas is retroperitoneal)
Pain may be relieved by leaning forward (retroperitoneal gland) Radiates Back Absent bowel sounds (due to paralytic ileus - develops quickly as pancreatic capsule is very poorly developed) |
|
|
Signs Pancreatitis?
|
Grey Turner - bruising flanks
Cullens sign - periumbilical discolouration |
|
|
Complications
|
Pseudocyst - localised collection pancreatic juices in lesser sack due to rupture of pancreatic duct
Pancreatic ascities - fluid pancreas drains into peritoneum |
|
|
Diagnose
|
Serum or urinary Amylase (amylase excreted by kidneys and may appear normal in serum therefore check urine amylase:creatinine ratioe 24-48hrs after onset)
Lipase concentration US or CT scan CRP is a good indicator of disease progress |
|
|
Other causes raised amylase
|
Intestinal ischaemia
Perforated peptic ulcer Ruptured ovarian cyst Parotitis (saliva amylase raised) I.e. anything that can rupture seems to raise amylase |
|
|
Management pancreatitis
|
Analgesia - pethidine
Fluids - crystalline or colloid Central line or swan ganz catheter (cath in pumonart artery) Urinary catheter Oxygen (hypoxia/ARDS) Nasogastric aspiration if paralytic ileus Insulin - hyperglycaemia Heparin NG tube for feeding Urgent ERCP if cholangitis to diagnose and treat choledocholithiasis DO NOT CORRECT HYPOCALCAEMIA UNLESS TETANY DEVELOPS |
|
|
Rx necrotic pancreas or abscess
|
Surgical debridement
|
|
|
Causes pancreatitis?
|
Gall stones
Ethanol Trauma Scorpian venom Mumps Autoimmune Steroids Hypercalcaemia (calcifies panc), hyperlipidaemia, hypothermia ERCP Drugs NB Hypercalcaemia causes panc, as calcium causes activation and release of panc enzymes, which are responsible for pancreatic damage |
|
|
Predict severity pancreatitis?
|
Modified glasgow criteria
PaO2 < 8kpa Age > 55 Neutrophils > 15 x10^9 Calcium: Hypocalcaemia Renal: Urea>16mmol/L Enzymes LDH + AST elevated Albumin < 32g/L Sugar glucose>10mmol/L |
|
|
Chronic pancreatitis
|
Due to:
1) Alcohol 80% 2) Calcified pancreas rest |
