Acute Pancreatitis, Study notes of Epidemiology

Download Acute Pancreatitis and more Study notes Epidemiology in PDF only on Docsity! Acute Pancreatitis Definition of acute pancreatitis: Inflammation of the pancreas, ranging from mild, self-limiting disease to complete necrosis of the entire organ. By definition, acute pancreatitis occurs on the background of a normal pancreas and can return to normal on resolution (cf. chronic pancreatitis, which has irreversible changes) Epidemiology of acute pancreatitis:  About 300 cases per million per year  Of these, 20% are mild and resolve without serious complications Causes of acute pancreatitis:  I – Idiopathic (most common)  G – Gallstones  E – Ethanol  T – Trauma  S – Steroids  M – Mumps  A – Autoimmune (eg. PAN)  S – Scorpion Venom – black Trinidadian scorpion (tityus trinitatis)  H – Hyperlipidaemia, Hypercalcaemia  E – ERCP  D – Drugs (azathioprine, thiazides, valproate, asparaginase, allopurinol)  And Pregnancy Presentations of acute pancreatitis:  History: o Severe epigastric pain, radiating through to the back o Pain worse on lying down and relieved sitting forward o Vomiting o Recent excess alcohol intake o Previous gallstone disease o FHx gallstones  Examination: o Tachycardia o Fever o Abdominal/epigastric tenderness o Jaundice o Rigid abdomen o Reduced bowel sounds o Periumbilical staining (Cullen’s sign) o Flank staining (Grey-Turner’s sign) o Shock Differential diagnosis of acute pancreatitis:  Any other cause of an acute abdomen  Myocardial infarction  Pericarditis  Aortic dissection Scoring systems for severity of acute pancreatitis: Glasgow criteria for predicting severity: PANCREAS mnemonic  PaO2 <8Kpa  Age < 55yrs  Neutrophils (WBC > 15)  Calcium <2mmol/L  Renal function (Urea > 16)  Enzymes (LDH > 600, AST > 200)  Albumin < 32g/L  Sugar > 10mmol/L 3 or more positive factors predicts a severe pancreatitis and the patient should be managed in an HDU/ITU setting. Initial management of acute pancreatitis: Current BSG guidance http://www.bsg.org.uk/images/stories/docs/clinical/guidelines/pancreatic/pancreatic.pdf  Blood tests: o Amylase – often >1000 but CAN be normal initially (esp if acute on chronic) o Lipase – more sensitive and specific than amylase but less readily available as a test o FBC (for neutrophils), U+Es (assess renal function), LFTs (for albumin and transaminases/bilirubin), Calcium  Arterial blood gas  Intravenous fluids – patients need prompt and adequate fluid resuscitation  Oxygen supplementation  Analgesia – patients usually require regular opiates  Feeding – if nutritional support is required then the enteral route should be the preferred option if this is tolerated. Further management of acute pancreatitis:  Antibiotics – Current evidence is not conclusive regarding prophylactic antibiotics to prevent infection of necrosis.  Antisecretory agents – there is no evidence to support the use of these in acute pancreatitis.  CT abdomen – current guidelines recommend this be done after 6-10 days if persisting signs of organ failure, ongoing sepsis or clinical deterioration. This can be performed earlier if there remains significant diagnostic uncertainty.  ERCP – urgent therapeutic ERCP with sphincterotomy should be performed within 72 hours in patients with acute severe pancreatitis and evidence of jaundice/common bile duct dilatation/cholangitis.  Surgical intervention – all patients with infected necrosis will require radiological or surgical drainage and/or surgical debridement. Complications of acute pancreatitis:  Early: o Shock o Acute kidney injury