acute pancreatitis
| put down that scorpion and step away slowly | |
|---|---|
| Etiology | Gallstones, alcohol and ERCP most common. Rarer causes: included in GET SMASHED |
| Epidemiology | |
| Clinical presentation | sudden, constant, severe epigastric pain relieved by leaning forward, radiating to back; N&V, shock RARE but classic: L flank ecchymosis (~Grey-Turner’s sign), periumbilical ecchymosis (Cullen’s sign) |
| Pathogenesis | ↑ capillary permeability - shock, third spacing SIRS due to cytokine release SIRS-associated cardiomyopathy + acidosis → ↓ cardiac output |
| Diagnostic investigations | calcium (↓ Ca is common), LFTs (gallstones?), WCC, clotting, lipids, IgG4 ➥ USS abdo: rule out gallstones ➥ CT: fat stranding, ↓ enhancement of pancreas ➥ serum amylase/lipase ≥3x normal (lipase more specific, less sensitive; ↑ longer than amylase) |
| Management | A-E, fluid resuscitation, NBM |
| Complications | ARDS, AKI, pseudocyst, abscess, pancreatic insufficiency with chronic pancreatitis, |
Risk stratification: modified Glasgow score
Based on:
- PaO2 <8 kpa
- Age >55 years
- Neutrophils >15
- Calcium <2 mmol/L
- Raised Urea >16 mmol/L
- Enzyme – LDH >600u/L
- Albumin <32g/L
- Sugar – Glucose >10 mmol/L