Acute Pancreatitis TBL

What EKG findings could be associated with acute pancreatitis

50% have ST elevation or depression

Diagnostic criteria for pancreatitis

At least 2 of the following: Abdominal pain (severe radiating to back) Serum lipase x3 ULN CT/MRI/US findings

What are local complications of pancreatitis

Necrosis Pseudocyst Ductal disruption - can lead to pleural effusion, pancreatic ascites, and enlarging fluid collection Vascular complications - splenic vein thrombosis, bleeding, pseudoaneurysm

Describe how cellular injury occurs in pancreatitis

Obstruction of pancreatic ducts leads to zymogens being trapped in acinar cells where they are activated and begin autodigestion. Also induce an inflammatory response Bile acids also can be taken up by acinar cells and damage the cells by increasing Ca and j

Common causes of pancreatitis - disease states, Environmental, Genetic

Gall stones T2DM Alcohol Meds Smoking ERCP complication Pancreas Divisum

What are the main risk factors for pancreatitis

Gall stones and alcohol

What lysosomal enzyme can activate trypsinogen leading to autodigestive injury

Cathepsin B

Whats the standard classification of pancreatitis

Atlanta Classification (Modified 2012): standard classification of severity of disease Mild - no peripancreatic necrosis and organ failure Moderate - sterile peripancreatic necrosis and/or transient organ failure (<48h) Severe - infected peripancreatic necroses or persistent organ failure (>48h) 1. PaO2 < 60% 2. Cr >152,6 umol/K 3. Shock (systolic BP < 60 mmHg) 4. GI bleeding (>500 mL/24 h) Critical - infected peripancreatic necroses and persistent organ failure

What imaging technique should be considered in pts with co-existing cholangitis or biliary obstruction w/ pancreatitis

ERCP early retrograde cholangiopancreatography

How can alcohol cause pancreatitis

EtOH is directly toxic to pancreas Possibly causes contraction of sphincter of oddi and subsequent blockage of duct Increases viscosity of pancreatic secretion via lithostatihine and glycoprotein 2, form protein plugs Destabilizes organelles containing digestive enzymes and increases the enzymes activity

How do we manage pancreatitis

Supplemental O2 Fluid resuscitation w/ Lactated Ringer's solution Pain management - priority Parenteral/enteral nutrition