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
