===== Pancreatitis =====

  * 80% - alcohol or gall stone disease.
    *biliary tract disease is more common cause in women vs alcoholism in men
  * recent excess alcohol, recent large meal.
  * PHx of gall stones, mumps, drugs (thiazides, sulphonamides)
  * Trauma
  * autosomal dominant – 80% with cationic trypsinogen gene will have recurrent pancreatitis

==== Presentation ====
  * abdo pain, vomiting, bloating, collapse
  * may not look “too unwell”
  * “Shock”. Chest may sound like CCF (leaking capillary syndrome)
  * tender epigastrium but often no guarding
  * Haemorrhagic pancreatitis: **Cullen's sign** – bluish left flank, **Grey Turner** sign – bluish about umbilicus. (signs of retroperitoneal haemorrhage - not specifically pancreas)

==== Management ====
  * >3x amylase, Lipase.(more specific than amylase) - may be normal in 20% if previous episodes have destroyed enough acinar tissue.
  * Coagulation screen, CXR (effusions, “CCF”), abn LFT's, raised WCC, hypocalcaemia
  * analgesia, anti-emetic
  * nil oral. NG if vomiting
  * aggressive IV N Saline fluid resuscitation,
  * antibiotic cover early in severe pancreatitis - Imipenem.
[{{ :wiki:gastroenterology:pancreatitis.png?400|**CUH pancreatitis**}}]
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<wrap notice>Ranson score for severity </wrap>
^  //on admission//  ||
^  |+1 for yes  |
^WCC  |>16  |
^Age |>55 |
^Glu |>10mmol/L |
^AST |>250 |
^LDH |>350 |
^  //within 48/24//  ||
^HCT drop |>10% from admission |
^Urea increase |0.9mmol/L from admission |
^Ca  |<2mmol/L within 24/24|
^Fluid sequestration  |>6L  |

==Mortality based on score==
  *<3 = 1%
  *3-4 = 15%
  *5-6 = 40%
  *>6 = 100%

<wrap notice box>Modified Glasgow Acute Pancreatitis severity score</wrap>
^PaO2< 7.9kPa | Yes +1 |
^Age > 55 years | Yes +1 |
^Neutrophils (WBC > 15) | Yes +1 |
^Calcium < 2 mmol/L | Yes +1 |
^Renal function: Urea > 16 mmol/L | Yes +1 |
^Enzymes LDH > 600IU/L | Yes +1 |
^Albumin < 32g/L (serum) | Yes +1 |
^Sugar (blood glucose) > 10 mmol/L | Yes +1 |
 
  *Score 0 to 2: 2% mortality
  *Score 3 to 4: 15% mortality
  *Score 5 to 6: 40% mortality
  *Score 7 to 8: 100% mortality

==References include:==
[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400340/| Haemorrhagic pancreatitis case report 2016]]\\ 
https://litfl.com/pancreatitis-ccc/\\