Table of Contents
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.
Ranson score for severity
| 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%
Modified Glasgow Acute Pancreatitis severity score
| 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