Pancreatitis

Acute Pancreatitis

  • Inflammation of the pancreas
  • Pancreatic enzymes (amylase / lipase) attack the pancreatic tissue
  • Cause epigastric pain radiating to the back
  • Diagnosed clinically / by rise in amylase (>3 x normal) / CT scan
  • Amylase may not rise in and acute exacerbation of chronic pancreatitis because the pancreas has lost it’s ability to produce the enzyme

 

There are many causes but in the real world you need to know:

  • Alcohol
  • Gallstones
  • Post- ERCP

 

Glascow Score

  • <2: mild
  • 2: moderate
  • >2: severe
  • Consider intensive care intervention/review when score is >1

 

PANCREAS Mneumonic for Glascow score (1 point for each answer)

  • P – Pa02 < 60
  • A – Age > 55
  • N – Neutrophils (WBC > 15)
  • C – Calcium < 2
  • R – uRea >16
  • E – Enzymes (LDH > 600 or AST/ALT >200)
  • A – Albumin < 32
  • S – Sugar (Glucose >10)

 

Complications

  • Pancreatitic necrosis
  • Infection in necrotic areas
  • Pseudocysts
  • Chronic pancreatitis

 

Management

  • Patients can become extremely sick very quickly
  • Escalate care according to Glascow score
  • Careful monitoring
  • IV fluids
  • Analgesia
  • Endoscopic drainage of large pseudocysts
  • Antibiotics only if evidence of infected pancreatic necrosis
  • Surgery to remove infected pancreatic necrosis
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