Pancreatitis
Acute pancreatitis
Causes
- Gall stones
- EtOH
- ERCP
- periampullary neoplasm
- blunt trauma
- scorpion bite (Tityus discrepens)
- viral infection: mumps, Coxsackie B
- drugs: azathioprine, valproate,
L-asparaginase, corticosteroids.
- hypothermia
- hyperlipidaemia
Presentation
Sudden onset epigastric pain radiating to the back. Nausea & vomiting.
Investigations
Bloods:
- FBC
- U&E,
Ca++
- LFT,
LDH
- ABG
Radiology (exclude perforated viscus)
ECG (exclude MI)
Δx
Mild pancreatitis: biliary colic. Severe pancreatitis: perforated viscus, MI.
Treatment
Largely conservative
- Assess Glasgow score (3 or more → ITU)
- Resuscitate with fluids
- Analgesia (pethidine + metoclopramide)
- If severe and a gall stone: ERCP, schincterotomy, gall stone removal
Surgery:
- Cholecystectomy (if due to a gall stone)
- Debride a necrotic pancreas
- Drain an abcess
- Drain a pancreatic pseudocyst
Octreotide SC may help with a pseudocyst.
Complications
Systemic:
- Shock
- DIC
- ARDS
- atelectasis
- pulmonary effusion
- ECG: ST changes simulating MI
Local:
- pancreatis abcess
- pancreatic pseudocyst (rupture, hge, infection)
- pancreatic ascites
- thrombosis of splenic vein, portal vein
-
-
Chronic pancreatitis
Causes
- EtOH (adults)
- CF (children)