Notesale: Turn your study into money

Document Preview

Extracts from the notes are below, to see the PDF you'll receive please use the links above

---

Grey: notes

Red: Important

Acute pancreatitis summary
Anatomy: Pancreas lies in the retropeitoneium and the head of the gland lies within the Cloop of the duodenum
...

Ducts of the pancreas:
1
...
The common bile duct
...

Content of the duodenum is prevented from entering the ampulla of vater by The
sphincter of Oddi
...
Third duct is the accessory pancreatic (also called duct of Santorini): It drains
into the duodenum
...

Veins: most of the pancreatic veins drain into the splenic vein
and then into the portal vein
...
Most of them end in the
pancreaticosplenic nodes that lie along splenic artery, while some drain into pyloric lymph
nodes, superior mesenteric lymph nodes or to the celiac lymph nodes via the hepatic
lymph nodes
...

Physiology of the pancreas:
Exocrine produce enzymes that are important to digestion including:
- Trypsin and chymotrypsin which digest proteins
- Amylase which digest carbohydrates
- Lipase which breaks down fats
...

As for the endocrine: Islets of Langerhans are distributed throughout the pancreas
...


Pancreatitis: may be acute or chronic
Pancreas usually returns to anatomical and functional normality after an acute
attack, while chronic pancreatitis is associated with a permanent derangement of
structure and function
...

The disease is relatively rare in children, but all adult age groups may be affected
...
Other etiologies include blunt trauma to the
abdomen, iatrogenic trauma (postoperative trauma, endoscopic retrograde
cholangiopancreatography), metabolic, mechanical, vascular, infectious, genetic and
autoimmune
...
The enzymes can damage tissue, activate the
complement system and the inflammatory cascade which leads to producing
cytokines and causing inflammation and edema to the pancreas
...

Classification of acute pancreatitis according to the revised Atlanta Classification:
Mild , moderately severe, and severe acute pancreatitis
...
The process is self-limiting and carries less than 1% mortality, most
common grade (80%-85% of patents with acute pancreatitis have mild pancreatitis)
- Moderately severe: associated with transient organ failure (<48 hours)
...

- Severe acute: acute pancreatitis with persistent organ dysfunction (>48 hours)
which carries an overall mortality rate of 4%
...
Some patients with pancreatic necrosis will develop infected pancreatic necrosis
...

- Nausea, vomiting are common
...

- Generalized abdominal and rebound tenderness may also occur in severe pancreatitis
...

An elevation of the serum amylase level 1
...
serum amylase increases
quickly within the first 12 hours after admission but usually returns to normal after 3-5
days
...


Red: Important

Grey: notes

This SIRS response may look like severe sepsis and cause injury to far sites and other
organs distinct from the pancreas
...

According to the revised Atlanta Classification, 2 out of 3 features are required for
diagnosing acute pancreatitis:
1
...
serum lipase or amylase levels 3 or more times higher than the normal range
3
...
Findings on plain films are nonspecific but are suggestive of acute
pancreatitis include:
1
...
The sentinel loop sign (which represents a focal dilated proximal jejunal loop in the
LUQ)
3
...

It allows complete visualization of the pancreas and retroperitoneum and can
be used as a prognostic indicator of the severity of acute pancreatitis
...

• Magnetic resonance cholangiopancreatography (MRCP) may benefit
selected cases by noninvasively visualizing the bile duct and pancreas
...

• Angiography: If acute hemorrhage or pseudoaneurysm is suspected or diagnosed
by US or CECT, a celiac or superior mesenteric arteriogram should be performed to
definitively assess the extent of vascular involvement
...

Treatment and management:
The most important stage of management of acute pancreatitis is the first 12 to 24 hours
of admission
...

• Conservative treatment:
1
...
IV Fluids: Lactated Ringer's solution is the recommended fluid of with an initial bolus
of 15 to 20 mL/kg and following rates of 3 mL/kg per hour for the first 24 hours
...
Keep patient NPO until abdominal pain, nausea, vomiting, appetite improve
4
...


Grey: notes

Red: Important

• ERCP: done with stone removal when acute pancreatitis results from gallstones
...

• Other surgical intervention indications include:
Pancreatic duct disruption, Pseudocysts (management: Percutaneous drainage),
Infected pancreatic necrosis (management: Surgical drainage, it must remove all
necrotic material and collections
...
Most often several operations are necessary
to remove all necrotic tissues
...

Complications:
Early Local complications: less than 4 weeks,
include: peripancreatic fluid collection, pancreatitic/peripancreatic necrosis
...

Systemic complications of acute pancreatitis: Sepsis, Acute Respiratory Distress
Syndrome, Renal failure, Hyperglycaemia and Obstructive jaundice
...

On admission
WBC

>16k

No = 0

Yes = +1

Age

>55

No = 0

Yes = +1

Glucose

>200mg/dL (>10mmol/L)

No = 0

Yes = +1

AST

>250

No = 0

Yes = +1

LDH

>350

No = 0

Yes = +1

48hrs into admission
Hct drop

>10% from admission

No = 0

Yes = +1

BUN increase

>5mg/dL from admission

No = 0

Yes = +1

Ca

<8mg/dL within 48hrs

No = 0

Yes = +1

Arterial pO2

<60mmHg within 48hrs

No = 0

Yes = +1

Base deficit(HCO3)

>4mg/dL within 48hrs

No = 0

Yes = +1

Fluid needs

>6L within 48hrs

No = 0

Yes = +1

Mortality estimation
0-2 criteria: <1% mortality
3-4 criteria: 16% mortality
5 or more: >40% mortality



---