Acute & Chronic Pancreatitis
Acute pancreatitis Chronic pancreatitis
Definition inflammation of pancreatic Definition structural integrity of
parenchyma w/ biochemical pancreas is permanently altered as a
associations of raised amylase + raised result of chronic inflammation
lipase enzymes on blood test
Signs + symptoms
Signs + symptoms Pain: epigastric, recurrent,
Pain (epigastric) radiates to back
radiates to back, relieved by
Anorexia
Nausea + vomiting
sitting forward, worse when
+ Grey Turner’s sign flank bruising eating/drinking heavily (typically
(rare) worse 15-20 mins after a meal)
+ Cullen’s sign Periumbilical Steatorrhoea
bruising (rare) Diabetes
Pancreatitis sequelae Aetiology ‘CAMP’
Peripancreatic fluid collections Cystic fibrosis
pseudocysts pancreatic necrosis Alcohol (80%)
pancreatic abscess haemorrhage Malnourishment
Pancreatic duct obstruction
Aetiology: ‘GET SMASHED’
Gallstones
Ethanol
Ix
Trauma AXR: pancreatic calcification in 30%
Steroids cases
Mumps (other: Coxsackie B) Reduced faecal elastase (assess
Autoimmune (polyarteritis nodosa) exocrine function)
Scorpion venom CT: shows calcification (more
Hypertriglyceridaemia, sensitive)
hyperchyloniconaemia, hypercalcaemia, MRCP
hypothermia
ERCP Mx
Drugs (e.g. Azanthioprine, mesalazine, Alcohol cessation
furosemide, steroids, sodium valproate)
Analgesia
Ix Pancreatic enzyme replacement
Raised serum amylase + lipase therapy
Detect cause e.g. USS gallstones?
CT- rule out complications
(not w/i 7hrs of acute presentation
Mx Modified Glasgow score
Symptomatic relief: NBM, IV fluids, PaO2 < 8kPa
analgesia Age >55 yrs
ERCP remove gallstones Neutrophils: WBC > 15 x 109/L
Rx underlying cause Calcium < 2mmol/L
Renal function (urea > 16mmol)
Enzymes (AST > 200iu/LDH >600)
Albumin < 32g/L
Sugar > 10mmol/L
≥ 3 w/i first 48 hrs severe pancreatitis
referral to HDU/ITU
< 3 severe pancreatitis unlikely)
Acute pancreatitis Chronic pancreatitis
Definition inflammation of pancreatic Definition structural integrity of
parenchyma w/ biochemical pancreas is permanently altered as a
associations of raised amylase + raised result of chronic inflammation
lipase enzymes on blood test
Signs + symptoms
Signs + symptoms Pain: epigastric, recurrent,
Pain (epigastric) radiates to back
radiates to back, relieved by
Anorexia
Nausea + vomiting
sitting forward, worse when
+ Grey Turner’s sign flank bruising eating/drinking heavily (typically
(rare) worse 15-20 mins after a meal)
+ Cullen’s sign Periumbilical Steatorrhoea
bruising (rare) Diabetes
Pancreatitis sequelae Aetiology ‘CAMP’
Peripancreatic fluid collections Cystic fibrosis
pseudocysts pancreatic necrosis Alcohol (80%)
pancreatic abscess haemorrhage Malnourishment
Pancreatic duct obstruction
Aetiology: ‘GET SMASHED’
Gallstones
Ethanol
Ix
Trauma AXR: pancreatic calcification in 30%
Steroids cases
Mumps (other: Coxsackie B) Reduced faecal elastase (assess
Autoimmune (polyarteritis nodosa) exocrine function)
Scorpion venom CT: shows calcification (more
Hypertriglyceridaemia, sensitive)
hyperchyloniconaemia, hypercalcaemia, MRCP
hypothermia
ERCP Mx
Drugs (e.g. Azanthioprine, mesalazine, Alcohol cessation
furosemide, steroids, sodium valproate)
Analgesia
Ix Pancreatic enzyme replacement
Raised serum amylase + lipase therapy
Detect cause e.g. USS gallstones?
CT- rule out complications
(not w/i 7hrs of acute presentation
Mx Modified Glasgow score
Symptomatic relief: NBM, IV fluids, PaO2 < 8kPa
analgesia Age >55 yrs
ERCP remove gallstones Neutrophils: WBC > 15 x 109/L
Rx underlying cause Calcium < 2mmol/L
Renal function (urea > 16mmol)
Enzymes (AST > 200iu/LDH >600)
Albumin < 32g/L
Sugar > 10mmol/L
≥ 3 w/i first 48 hrs severe pancreatitis
referral to HDU/ITU
< 3 severe pancreatitis unlikely)
