Acute Pancreatitis .pptx

Powerpoint presentation on Acute Pancreatitis, to aid management and recognition in the emergency department.

1. Scenario One

2. Scenario Two While in the ED, a 50-year-old female presents with sudden onset abdominal pain. She mentions she felt warm to touch and her partner had noticed her eyes looked a bit yellow. She had taken paracetamol to help with the pain, but it wasn’t helping. She explained that the pain seemed to be worse after eating meals. On examination, there was epigastric pain, radiating to the back, sclerus icterus, and a temperature of 37.9

3. Acute Pancreatitis By Dr. Gboneme Sandra Junior Clinical Fellow in Medicine George Eliot NHS Trust

4. Outline Introduction Theory Etiology History and Exam Investigations Criteria Treatment options Differentials Summary Questions ?

5. Introduction Acute Pancreatitis is an acute inflammation and hemorrhaging of the pancreas due to its own digestive enzymes. It is a common cause of acute abdominal pain . Grouped into Mild, Moderate, Severe Mild: No systemic complications , or organ involvement Moderate; associated systemic complications or transient organ failure, resolves in 48 hours . Severe: resolves in greater than 48 hours.

6. Theory Pancreas is located retroperitoneally in the epigastric region. Pancreas plays both endocrine and exocrine role; Exocrine role: Acinar cells produce digestive enzymes that help digest food The pancreas protects itself by producing enzymes in their inactive form These enzymes are called zymogens/ tripsinogen and are kept in zymogen granules. Usually, zymogens are activated by Proteases.

7. Etiology

8. History and Examination Mid-Epigastric Pain or Left upper quadrant pain radiating to the back Nausea and Vomiting Signs of hypovolemia ( decreased skin turgor, hypotension, oliguria) Signs of pleural effusion 9especially due to pulmonary dysfunction) Anorexia/ Lack of appetite ABDOMINAL EXAM: Tender abdomen with voluntary guarding Signs of SIRS: Tachypnoea, tachycardia, temperature spikes Jaundice Cullen’s/Grey turner sign

9. Investigations SERUM TRYPSIN: Most accurate but not routinely available LIPASE AMYLASE ROUTINE BLOODS; FBC, U and E, LFT, CRP Calcium: Hypercalcemia and Hypocalcemia Serum Triglycerides ( if not gallstone or alcohol ) consider if >11.3 mmol IMAGING; Contrast Enhanced CT Abdo ( not necessary for diagnosis)

10. Bedside Index of Severity in Acute Pancreatitis (BISAP) Score BUN > 8.9mmol/L (1 point) Abnormal mental status with a GCS of <15 (1 point) Evidence of SIRS (1 point ) Patient age > 60 years old ( 1 point) Imaging Study reveals pleural effusion ( 1 point ) 0 to 2 points: Lower Mortality 3 to 5 points: Higher Mortality

11. APACHE II

12. Treatment ABC of Resuscitation FLUID RESUSCITATION Pain control Antiemetic Alcohol related: Replace Thiamine and other vitamins Antibiotics if infection is implicated Early nutritional support, parenteral if neccessary

13. Differentials PUD Intestinal obstruction Cholecystitis Hepatitis

14. Summary In Summary, Acute pancreatitis is a common presentation in the ED, and is one that should not be missed. It requires a high index of suspicion with alcohol and gallstones being the most common causes . With regards to investigations; Serum Lipase/Amylase is the key investigation and tends to be 3x the higher normal Fluid resuscitation is important, as well as pain control.

15. Scenario three A 60-year-old man comes to the emergency complaining of severe epigastric abdominal pain that radiates to the back. Pain improves when he leans forward. It is worse when he breathes in deeply. He also complains of nausea, vomiting and loss of appetite. He smokes 10 cigarettes and drinks 14 units of alcohol per day. On examination, he has tachycardia, tachypnoea and low blood pressure. There are decreased breath sounds over the base of his left lung. His routine Bloods showed: BUN 9.9mmol, WBC; 14,000, CRP: 117, Neut : 11,000, adjusted calcium: 2.0 What is his BISAP score ? What extra tests would you request? What management would you recommend ?

16. Questions? Thank you very much.