Pancreatitis: Difference between revisions

Latest revision as of 13:41, 24 August 2020

Definition

Inflammation of the pancreas

Etiology

Gallstone
Alcohol
Tumour/Trauma
Scorpion sting (Trinidadian)
Microbiological
- Viral: Mumps, Rubella, Varicella, Viral hepatitis, CMV/EBV/HIV, Coxsackievirus/Echovirus/Adenovirus
- Bacterial: Mycoplasma, Campylobacter, Mycobacterium tuberculosis, Mycobacterium avium intracellular, Legionella, Leptospirosis
- Parasitic: Ascariasis, Clonorchiasis, Echinococcus
Autoimmune: SLE, Polyarteritis nodosa, Crohn disease
Surgery: ERCP
Hyperlipidemia
Hypercalcemia
Hypothermia
Emboli/Ischemia
Drugs
- Steroids
- Azathioprine
- Furosemide
- Mercaptopurine
- Estrogen
- Methyldopa
- H₂ blockers
- Valproic acid
- Antibiotics: ampicillin, penicillin, ceftriaxone, isoniazid, macrolides, metronidazole, nitrofurantoin, rifampin, sulfonamides, tetracyclines
- Antivirals: didanosine, interferon/ribavirin, nelfinavir, ritonavir
- Antifungals: 5-fluorouracil, pentamidine, stibogluconate
- Acetaminophen
- Salicylates
- Methanol
- Organophosphates

Clinical Manifestations

Acute abdominal pain, usually epigastric, sometimes radiating to the back
Nausea and vomiting
Fever
Dyspnea
Can lead to both endocrine and exocrine dysfunction, including diabetes mellitus and malabsorption

Prognosis

Ranson's Criteria

On presentation
- Sugar > 10
- WBC > 16k
- Elderly > 55 years
- LDH > 350
- AST > 250
After 48h
- Hct drop >10% from admission
- BUN increase >5 mg/dL (>1.79 mmol/L) from admission
- Ca <8 mg/dL (<2 mmol/L) within 48 hours
- Arterial pO2 <60 mmHg within 48 hours
- Base deficit (24 - HCO3) >4 mg/dL within 48 hours
- Fluid needs > 6L within 48 hours

BISAP

BUN > 8.9
Impaired LOC
SIRS
Age > 60
Pleural effusion

Differential Diagnosis

Other causes of acute abdominal pain, including peptic ulcer disease, gallstones, cholangitis, cholecystitis, gastrointestinal perforation, intestinal obstruction, mesenteric ischemia, and hepatitis

Diagnosis

Made based on the presence of two of the following three criteria:
- Compatible history
- Elevated lipase or amylase
- Characteristic findings on imaging

Management

Pancreatic Necrosis

Two forms
- Acute necrotizing pancreatitis, which is present at the start, and is usually phlegmonous
- Walled-off necrosis, which develops over the course of illness, and is usually an organized collection
Both are sterile and both can become infected
No antibiotics warranted in acute necrotizing pancreatitis
Infection usually develops after about 10 days
If necrosectomy is indicated, it should be delayed by at least 4 weeks

Splenic Vein Thrombosis

Monitor

@@ Line 10: / Line 10: @@
 *Scorpion sting (Trinidadian)
 *Microbiological
+**Viral: [[Mumps]], [[Rubella]], [[Varicella]], [[Viral hepatitis]], [[CMV]]/[[EBV]]/[[HIV]], [[Coxsackievirus]]/[[Echovirus]]/[[Adenovirus]]
-**Viral
+**Bacterial: [[Mycoplasma]], [[Campylobacter]], [[Mycobacterium tuberculosis]], [[Mycobacterium avium intracellular]], [[Legionella]], [[Leptospirosis]]
-***[[Mumps]]
+**Parasitic: [[Ascariasis]], [[Clonorchiasis]], [[Echinococcus]]
-***[[Rubella]]
+*Autoimmune: [[SLE]], [[Polyarteritis nodosa]], [[Crohn disease]]
-***[[Varicella]]
-***[[Viral hepatitis]]
-***[[CMV]]/[[EBV]]/[[HIV]]
-***[[Coxsackievirus]]/[[Echovirus]]/[[Adenovirus]]
-**Bacterial
-***[[Mycoplasma]]
-***[[Campylobacter]]
-***[[Mycobacterium tuberculosis]]
-***[[Mycobacterium avium intracellular]]
-***[[Legionella]]
-***[[Leptospirosis]]
-**Parasitic
-***[[Ascariasis]]
-***[[Clonorchiasis]]
-***[[Echinococcus]]
-*Autoimmune
-**[[SLE]]
-**[[Polyarteritis nodosa]]
-**[[Crohn disease]]
 *Surgery: [[ERCP]]
 *[[Hyperlipidemia]]
@@ Line 46: / Line 28: @@
 **H<sub>2</sub> blockers
 **[[Valproic acid]]
+**[[Antibiotics]]: [[ampicillin]], [[penicillin]], [[ceftriaxone]], [[isoniazid]], [[macrolides]], [[metronidazole]], [[nitrofurantoin]], [[rifampin]], [[sulfonamides]], [[tetracyclines]]
-**[[Antibiotics]]
+**[[Antivirals]]: [[didanosine]], [[interferon]]/[[ribavirin]], [[nelfinavir]], [[ritonavir]]
+**[[Antifungals]]: [[5-fluorouracil]], [[pentamidine]], [[stibogluconate]]
 **[[Acetaminophen]]
 **[[Salicylates]]
@@ Line 54: / Line 38: @@
 ==Clinical Manifestations==
-*Acute abdominal pain, usually epigastric, sometimes radiating to the back
+*[[Causes::Acute abdominal pain]], usually [[Causes::epigastric pain|epigastric]], sometimes radiating to the back
-*Nausea, vomiting
+*[[Causes::Nausea]] and [[Causes::vomiting]]
+*[[Causes::Fever]]
-*Fevers
-*Dyspnea
+*[[Causes::Dyspnea]]
+*Can lead to both endocrine and exocrine dysfunction, including [[diabetes mellitus]] and [[malabsorption]]
-==Management==
+=== Prognosis ===
-===Pancreatic necrosis===
+====Ranson's Criteria====
-*Two forms
-**Acute necrotizing pancreatitis, which is present at the start, and is usually phlegmonous
-**Walled-off necrosis, which develops over the course of illness, and is usually an organized collection
-*Both are sterile and both can become infected
-*No antibiotics warranted in acute necrotizing pancreatitis
-*Infection usually develops after about 10 days
-*If necrosectomy is indicated, it should be delayed by at least 4 weeks
-===Splenic vein thrombosis===
-*Monitor
-==Prognosis==
-===Ranson's criteria===
 *On presentation
@@ Line 93: / Line 62: @@
 **Fluid needs &gt; 6L within 48 hours
-===BISAP===
+====BISAP====
 *BUN &gt; 8.9
@@ Line 100: / Line 69: @@
 *Age &gt; 60
 *Pleural effusion
+== Differential Diagnosis ==
+* Other causes of [[acute abdominal pain]], including [[peptic ulcer disease]], [[gallstones]], [[cholangitis]], [[cholecystitis]], [[gastrointestinal perforation]], [[intestinal obstruction]], [[mesenteric ischemia]], and [[hepatitis]]
+== Diagnosis ==
+* Made based on the presence of two of the following three criteria:
+** Compatible history
+** Elevated lipase or amylase
+** Characteristic findings on imaging
+==Management==
+===Pancreatic Necrosis===
+*Two forms
+**Acute necrotizing pancreatitis, which is present at the start, and is usually phlegmonous
+**Walled-off necrosis, which develops over the course of illness, and is usually an organized collection
+*Both are sterile and both can become infected
+*No antibiotics warranted in acute necrotizing pancreatitis
+*Infection usually develops after about 10 days
+*If necrosectomy is indicated, it should be delayed by at least 4 weeks
+===Splenic Vein Thrombosis===
+*Monitor
 [[Category:Gastroenterology]]