Pancreatitis: Difference between revisions

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== Definition ==
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==Definition==
   
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* Inflammation of the pancreas
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*Inflammation of the pancreas
   
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== Etiology ==
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==Etiology==
   
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*'''[[Gallstone]]'''
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* Gallstones
  
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*'''Alcohol'''
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* Ethanol
  
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* Tumour/Trauma
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*Tumour/Trauma
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* Scorpion sting (Trinidadian)
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*Scorpion sting (Trinidadian)
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* Microbiological
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*Microbiological
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**Viral: [[Mumps]], [[Rubella]], [[Varicella]], [[Viral hepatitis]], [[CMV]]/[[EBV]]/[[HIV]], [[Coxsackievirus]]/[[Echovirus]]/[[Adenovirus]]
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** Viral
  
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**Bacterial: [[Mycoplasma]], [[Campylobacter]], [[Mycobacterium tuberculosis]], [[Mycobacterium avium intracellular]], [[Legionella]], [[Leptospirosis]]
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*** Mumps
  
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**Parasitic: [[Ascariasis]], [[Clonorchiasis]], [[Echinococcus]]
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*** Rubella
  
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*Autoimmune: [[SLE]], [[Polyarteritis nodosa]], [[Crohn disease]]
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*** Varicella
  
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*Surgery: [[ERCP]]
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*** Viral hepatitis
  
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*[[Hyperlipidemia]]
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*** CMV/EBV/HIV
  
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*[[Hypercalcemia]]
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*** Coxsackie virus/Echovirus/Adenovirus
  
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*[[Hypothermia]]
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** Bacterial
  
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*Emboli/Ischemia
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*** Mycoplasma
  
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*Drugs
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*** Campylobacter
  
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**[[Steroids]]
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*** Mycobacterium tuberculosis
  
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**[[Azathioprine]]
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*** Mycobacterium avium intracellular
  
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**[[Furosemide]]
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*** Legionella
  
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**[[Mercaptopurine]]
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*** Leptospirosis
  
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**[[Estrogen]]
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** Parasitological
  
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**[[Methyldopa]]
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*** Ascariasis
  
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**H<sub>2</sub> blockers
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*** Clonorchiasis
  
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**[[Valproic acid]]
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*** Echinococcus
  
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**[[Antibiotics]]: [[ampicillin]], [[penicillin]], [[ceftriaxone]], [[isoniazid]], [[macrolides]], [[metronidazole]], [[nitrofurantoin]], [[rifampin]], [[sulfonamides]], [[tetracyclines]]
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* Autoimmune
  
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**[[Antivirals]]: [[didanosine]], [[interferon]]/[[ribavirin]], [[nelfinavir]], [[ritonavir]]
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** SLE
  
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**[[Antifungals]]: [[5-fluorouracil]], [[pentamidine]], [[stibogluconate]]
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** Polyarteritis nodosa
  
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**[[Acetaminophen]]
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** Crohn's disease
  
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**[[Salicylates]]
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* Surgery: ERCP
  
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**[[Methanol]]
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* Hyperlipidemia
  
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**[[Organophosphates]]
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* Hypercalcemia
  
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* Hypothermia
  
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* Emboli/Ischemia
  
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* Drugs
  
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** Steroids
  
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** Azathioprine
  
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** Furosemide
  
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** Mercaptopurine
  
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** Estrogen
  
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** Methyldopa
  
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** H2 blockers
  
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** Valproic acid
  
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** Antibiotics
  
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** Acetaminophen
  
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** Salicylates
  
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** Methanol
  
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** Organophosphates
  
   
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== Clinical Manifestations ==
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==Clinical Manifestations==
   
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* Acute abdominal pain, usually epigastric, sometimes radiating to the back
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*[[Causes::Acute abdominal pain]], usually [[Causes::epigastric pain|epigastric]], sometimes radiating to the back
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* Nausea, vomiting
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*[[Causes::Nausea]] and [[Causes::vomiting]]
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*[[Causes::Fever]]
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* Fevers
  
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* Dyspnea
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*[[Causes::Dyspnea]]
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*Can lead to both endocrine and exocrine dysfunction, including [[diabetes mellitus]] and [[malabsorption]]
   
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== Management ==
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=== Prognosis ===
   
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====Ranson's Criteria====
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=== Pancreatic necrosis ===
  
   
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*On presentation
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* Two forms
  
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**Sugar &gt; 10
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** Acute necrotizing pancreatitis, which is present at the start, and is usually phlegmonous
  
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**WBC &gt; 16k
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** Walled-off necrosis, which develops over the course of illness, and is usually an organized collection
  
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**Elderly &gt; 55 years
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* Both are sterile and both can become infected
  
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**LDH &gt; 350
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* No antibiotics warranted in acute necrotizing pancreatitis
  
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**AST &gt; 250
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* Infection usually develops after about 10 days
  
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*After 48h
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* If necrosectomy is indicated, it should be delayed by at least 4 weeks
  
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**Hct drop &gt;10% from admission
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**BUN increase &gt;5 mg/dL (&gt;1.79 mmol/L) from admission
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**Ca &lt;8 mg/dL (&lt;2 mmol/L) within 48 hours
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**Arterial pO2 &lt;60 mmHg within 48 hours
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**Base deficit (24 - HCO3) &gt;4 mg/dL within 48 hours
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**Fluid needs &gt; 6L within 48 hours
   
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====BISAP====
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=== Splenic vein thrombosis ===
  
   
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*BUN &gt; 8.9
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* Monitor
  
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*Impaired LOC
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*SIRS
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*Age &gt; 60
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*Pleural effusion
   
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== Prognosis ==
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== Differential Diagnosis ==
   
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* Other causes of [[acute abdominal pain]], including [[peptic ulcer disease]], [[gallstones]], [[cholangitis]], [[cholecystitis]], [[gastrointestinal perforation]], [[intestinal obstruction]], [[mesenteric ischemia]], and [[hepatitis]]
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=== Ranson's criteria ===
  
   
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== Diagnosis ==
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* On presentation
  
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** Sugar &gt; 10
  
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** WBC &gt; 16k
  
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** Elderly &gt; 55 years
  
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** LDH &gt; 350
  
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** AST &gt; 250
  
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* After 48h
  
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** Hct drop &gt;10% from admission
  
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** BUN increase &gt;5 mg/dL (&gt;1.79 mmol/L) from admission
  
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** Ca &lt;8 mg/dL (&lt;2 mmol/L) within 48 hours
  
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** Arterial pO2 &lt;60 mmHg within 48 hours
  
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** Base deficit (24 - HCO3) &gt;4 mg/dL within 48 hours
  
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** Fluid needs &gt; 6L within 48 hours
  
   
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* Made based on the presence of two of the following three criteria:
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=== BISAP ===
  
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** Compatible history
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** Elevated lipase or amylase
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** Characteristic findings on imaging
   
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==Management==
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* BUN &gt; 8.9
  
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* Impaired LOC
  
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===Pancreatic Necrosis===
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* SIRS
  
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* Age &gt; 60
  
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*Two forms
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* Pleural effusion
  
  +
**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===
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  +
*Monitor
   
 
[[Category:Gastroenterology]]
  
[[Category:Gastroenterology]]

Latest revision as of 09:41, 24 August 2020

Definition

  • Inflammation of the pancreas

Etiology

Clinical Manifestations

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

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
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