Acute Pancreatitis
SUMMARY
Symptoms
Risk Factors
I GET SMASHED
Signs
Investigations
Blood: Lipase, ABG (monitor oxygenation/ acid-base status), FBC+CRP, UEC (fluid loss)
Imaging: CT (gold standard), AXR (no psoas shadow = inc retroperitoneal fluid), US (gallstones), ERCP (CBD stones)
Management
Symptoms
- Gradual/ sudden severe epigastric/ central abdo pain
- Radiates to back
- Sitting forward alleviates
- n+v
- Diarrhoea
Risk Factors
I GET SMASHED
Signs
- Tachycardia, fever, jaundice, shock
- Rigid abdo, local/ generalised tenderness, ileus
- Cullen's (periumbilical)/ Grey Turner (flank bruising) sign (bv autodigestion/ retroperitoneal haemorrhage)
- Oligouria
Investigations
Blood: Lipase, ABG (monitor oxygenation/ acid-base status), FBC+CRP, UEC (fluid loss)
Imaging: CT (gold standard), AXR (no psoas shadow = inc retroperitoneal fluid), US (gallstones), ERCP (CBD stones)
Management
- NBM, analgesia
- IVI N saline to counter 3rd space loss
- Supportive (vitals, volume - urine output)
- ERCP + gallstone removal if jaundiced/ treat or removal cause
- (Necrotomy)
Pathogenesis
Autodigestion by pancreatic enzymes, oedema + fluid shift into extracellular space (bowels)
Aetiology
I diopathic
G allstones**
E tOH**
T umours
S urgery/ trauma (ERCP)
M icrobiological (Virus: mumps, HSV
A utoimmune (SLE, polyarteritis)
S corpion bite
H yperCa2+
E mobli/ ischaemia
D rugs
**Common
Clinical Features
Symptoms
Investigations
Bloods:
Imaging:
Treatment
Source
Dr Ray Wilson 2014
OHCM 9th Ed 2014
Autodigestion by pancreatic enzymes, oedema + fluid shift into extracellular space (bowels)
Aetiology
I diopathic
G allstones**
E tOH**
T umours
S urgery/ trauma (ERCP)
M icrobiological (Virus: mumps, HSV
A utoimmune (SLE, polyarteritis)
S corpion bite
H yperCa2+
E mobli/ ischaemia
D rugs
**Common
Clinical Features
Symptoms
- Pain
- Vomiting
- Diarrhoea
- Epigastric tenderness
- inc HR
- dec BP
- Fever
- Hypoxemia
- Oligouria
- Altered mental state
- Coagulopathy
- Cullen's sign (bruising inf to umbilicus)
- Grey Turner's sign (flank bruising)
Investigations
Bloods:
- FBC, UEC
- Lipase
Imaging:
- US (gallstone in CBD)
- CT (necrosis)
Treatment
- Treat cause/ complications
- ICU
- Surgical:
- ERCP
- Necrosectomy
Source
Dr Ray Wilson 2014
OHCM 9th Ed 2014