Pancreatitis

Goldman-Cecil Medicine, 144, 959-967.e2

Forsmark, Chris E.;

Component Pancreatitis
Pathophysiology Inflammatory disorder of the pancreas with abdominal pain
The process leads to activation of zymogens inappropriately
inside the pancreas. Trypsin is a key factor.
Oedema can cause the pancreas to swell.
Trypsin and other enzymes cause more damage in more severe
cases. Thus leading to pancreatic necrosis.
Epidemiology Causes: Alcohol, Gall stones ~80% [GET SMASHED]
Time Course Variable
Clinical Features Mild
– Abdo pain
– Minimal resolving abdo signs
– Moderate tachycardia
Severe
– Severe abdo pain
– Severe toxaemia
– General peritonitis
– Acute respiratory distress syndrome

Diagnosis + Investigations Pancreatic enzymes in plasma

– Serum amylase [raised]
– Lipase [raised]
Liver function test for gall stone pancreatitis
Pancreas MNEMONIC for severity
– P = PAO2
– A = AGE
– N = Neutrophil count
– C = Calcium
– R = Raised plasma urea
– A = Albumin
– S = Sugar
Blood test
USS of gall bladder or CT
Management Mild = Fluid resuscitation and analgesia
Severe = Death may occur via systemic toxaemia (SIRS),
shock and multiple organ dysfunction syndrome (MODS).
– Fluid resuscitation
– NG tube
– Admit to ICU
– Monitor: ABG, Haemoglobin, WBC count, Plasma
electrolytes, CRP and Bilirubin, ALK Phos, Plasma proteins