MRCS Knowledge: Acute Pancreatitis
16/09/14 20:14 Filed in: MRCS Knowledge
MRCS Part B Knowledge: Acute Pancreatitis
Today’s MRCS Knowledge short notes are on acute pancreatitis.
Background
Inflammation of pancreas with release of inflammatory cytokines and pancreatic enzymes
Aetiology
Signs and Symptoms
• Epigastric tenderness and guarding, septic shock
• Cullen’s Sign: periumbilical bruising
• Grey-Turner’s Sign: bilateral flank bruising indicates pancreatic necrosis with retroperitoneal bleeding
• Severe epigastric pain radiating to back and, relieved by sitting forward, nausea, vomiting
Investigations
• Bloods: FBC, U&E, LFTs, sSerum aAmylase >1000Iu/mL, lipase, ABG
• AXR: loss of psoas shadow indicates retroperitoneal fluid
• USS: gallstones, pancreatic fluid
• CT Abdo: pancreatic inflammation, fluid (see image at top of page)
Management
Immediate: resuscitate, IVI fluids, O2 and assess severity (see prognosis)
Early ERCP if gallstone identified
Transfer to HDU/ITU for monitoring of vital signs and fluid balance with nutritional support
Prognosis
Complications: pancreatic pseudocyst, pancreatic necrosis, chronic pancreatitis, ARDS, SIRS, death
Several classification systems for severity Glasgow Imrie, Ranson and APACHE II
Further Info:
For further info and commonly asked questions on acute pancreatitis be sure to sign up to the Question Bank.
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