Pancreatitis Notes


Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Pancreatitis essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Pancreatitis:

Pancreatic pseudocyst

Acute pancreatitis

Chronic pancreatitis

NOTES NOTES PANCREATITIS GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Inflammation of pancreas SIGNS & SYMPTOMS ▪ Upper abdominal pain radiating to back; nausea; vomiting TYPES DIAGNOSIS ▪ Acute, chronic DIAGNOSTIC IMAGING CAUSES ▪ Acute ▫ Gallstones, alcoholism, direct trauma, infections (mumps) ▪ Chronic ▫ Recurrent acute pancreatitis, chronic alcoholism, cystic fibrosis ▪ Abdominal CT scan; ultrasound LAB RESULTS ▪ Clinical, lab findings; see individual disorders TREATMENT RISK FACTORS ▪ Smoking OTHER INTERVENTIONS ▪ Dietary modifications, symptomatic treatment PANCREATIC PSEUDOCYST PATHOLOGY & CAUSES ▪ Localized fluid collection of pancreatic enzymes, necrotic debris and blood encapsulated by non-epithelialized wall (hence the name pseudocyst) composed of fibrous and granulation tissue ▪ Usually take up to 4–6 weeks to develop, unlike acute fluid collections ▪ Occurs due to disruption of pancreatic duct → accumulation of pancreatic fluid → hemorrhagic fat necrosis → inflammatory reaction → encapsulation of fluid by fibrous and granulation tissue CAUSES ▪ Arises as complication of acute/chronic pancreatitis/abdominal trauma COMPLICATIONS ▪ Infection; hemorrhage ▪ Compression of the gastrointestinal/urinary/ OSMOSIS.ORG 345
biliary tract ▪ Rupture → spilling of enzymes and debris into abdominal cavity → diffuse peritonitis SIGNS & SYMPTOMS ▪ Abdominal discomfort, indigestion, anorexia, abdominal mass DIAGNOSIS DIAGNOSTIC IMAGING CT scan ▪ Large cyst cavity of low attenuation surrounded by well-defined enhancing wall within, around pancreas ▪ Calcifications ▪ If present, complications may be visualized Ultrasound ▪ Visualization of hypoechoic/anechoic cystic fluid collections MRI ▪ Not necessary, but useful for distinguishing from organized necrosis LAB RESULTS Cyst fluid analysis ▪ To distinguish from tumor ▫ ↓ carcinoembryonic antigen (CEA) ▫ ↑ cmylase ▫ ↓ cluid viscosity 346 OSMOSIS.ORG Figure 40.1 A CT scan in the axial plane demonstrating a pancreatic pseudocyst. TREATMENT ▪ Initially ▫ Bowel rest, total parenteral nutrition (TPN), observation SURGERY ▪ If symptoms do not improve ▫ Surgical drainage to establish connection which drains pseudocystic fluid into small intestine (cystojejunostomy), stomach (cystogastrostomy), or duodenum (cystoduodenostomy) ▪ Endoscopic drainage
Chapter 40 Pancreatitis PANCREATITIS (ACUTE) PATHOLOGY & CAUSES ▪ Sudden inflammation of pancreas due to autodigestion → reversible pancreatic injury. TYPES Mild ▪ Inflammation, parenchymal edema, peripancreatic fat necrosis Severe ▪ Parenchymal necrosis, hemorrhage CAUSES ▪ See mnemonic for summary of causes MNEMONIC: I GET SMASHED Causes of Acute pancreatitis Idiopathic Gallstones Ethanol abuse Trauma Steroids Mumps infection Alcohol abuse Scorpion sting Hypertriglyceridemia, hypercalcemia Endoscopic retrograde cholangiopancreatography Drugs: sulfa drugs, reversetranscriptase inhibitors, protease inhibitors Alcohol ▪ Increases zymogen secretion; decreases fluid, bicarbonate production → pancreatic juices become thick, viscous → pancreatic duct blocked ▪ Stimulates release of inflammatory cytokines ▪ Oxidative metabolism produces free radicals Gallstones ▪ Lodge at Oddi sphincter → pancreatic duct blocked Alcohol and gallstones ▪ Pancreatic duct blocked → pancreatic juices back up → pressure increases → zymogen granules fuse with lysosomes → trypsinogen transforms into activated trypsin → digestive enzyme activation, autodigestion RISK FACTORS ▪ Biologically male to biologically female, 1:3 ▪ Smoking COMPLICATIONS ▪ Most often ▫ Acute pseudocyst, intra-abdominal infection, pancreatic abscess, disseminated intravascular coagulation (DIC), internal pancreatic fistula ▪ Severe manifestations ▫ Acute respiratory distress syndrome (ARDS), acute renal failure, hemorrhage, hypotensive shock OSMOSIS.ORG 347
TREATMENT SIGNS & SYMPTOMS ▪ Abdominal pain; loss of appetite; palpable, tender mass ▪ Cullen’s sign ▫ Periumbilical region bruising ▪ Grey Turner’s sign ▫ Bruising along flank MEDICATIONS ▪ Pain management, hydration, electrolytes ▪ Hyperbaric oxygen therapy, antibiotics SURGERY ▪ Necrosectomy OTHER INTERVENTIONS ▪ Total restriction of food intake, alcohol cessation ▪ Endoscopic retrograde cholangiopancreatography (ERCP) Figure 40.2 Cullen’s sign. Individual presented with a four-day history of abdominal pain following an alcohol binge. DIAGNOSIS DIAGNOSTIC IMAGING CT scan ▪ Visualization of inflammation, necrosis, abscess, pancreatic pseudocysts Ultrasound ▪ Gallstones LAB RESULTS ▪ Elevated serum amylase, lipase, bilirubin OTHER DIAGNOSTICS Histology ▪ Microvascular edema; fat tissue necrosis; acute inflammation; destruction of parenchyma, blood vessels; interstitial hemorrhage 348 OSMOSIS.ORG Figure 40.3 A CT scan in the axial plane demonstrating acute pancreatitis. There is diffuse enlargement of the pancreas associated with peripancreatic fluid.
Chapter 40 Pancreatitis PANCREATITIS (CHRONIC) PATHOLOGY & CAUSES ▪ Persistent, chronic inflammation of pancreas due to autodigestion → irreversible injury of exocrine, endocrine pancreas ▪ Fibrosis, calcification ▫ Prolonged inflammation produces fibrogenic cytokines, transforming growth factor beta (TGF-beta), plateletderived growth factor (PDGF) → activates myofibroblasts → collagen production, fibrosis ▫ Early stages: Langerhans islets not affected ▫ Advanced: atrophy, fibrosis of islets CAUSES ▪ See mnemonic for summary of causes ▪ Genetic ▫ Hereditary chronic pancreatitis: autosomal-dominant disease due to mutations in cationic trypsinogen gene ▫ Cystic fibrosis: cystic fibrosis transmembrane conductance regulator (CFTR) mutation → decreased bicarbonate secretion → pancreatic duct plugged, obstructed ▪ Autoimmune ▫ Distinct form of chronic pancreatitis → manifestation of immunoglobulin G (IgG) related disease COMPLICATIONS ▪ Pancreatic pseudocyst; ascites; pancreatic insufficiency; diabetes mellitus; vitamins A, D, E, K deficiency; pancreatic cancer MNEMONIC: TIGAR-O Causes of Chronic pancreatitis Toxins: chronic alcoholism Idiopathic Genetic Autoimmune Recurrent acute pancreatitis Obstruction: gallstones, pancreatic head tumor SIGNS & SYMPTOMS ▪ Severe abdominal pain radiates to back; nausea; vomiting; steatorrhea; weight loss; edema due to malabsorption DIAGNOSIS DIAGNOSTIC IMAGING CT scan ▪ Visualization of pancreatic ducts dilatation, calcifications, atrophy, pseudocysts Ultrasound ▪ Hyperechogenicity (fibrosis), pseudocysts, pseudoaneurysms, ascites ERCP/magnetic resonance cholangiopancreatography (MRCP) ▪ Visualization of pancreatic ducts; chain-oflakes pattern due to alternating stenosis, dilation LAB RESULTS ▪ Mildly elevated serum amylase, alkaline phosphatase, bilirubin OSMOSIS.ORG 349
OTHER DIAGNOSTICS Histology ▪ Dilatation of pancreatic ducts; acinar cell atrophy; fibrosis; chronic inflammatory infiltrate; protein plugs, calcifications TREATMENT MEDICATIONS ▪ Pain management ▪ Pancreatic enzyme replacement SURGERY Endoscopy, surgery ▪ Resectional/drainage procedures for pseudocyst, fistula, ascites OTHER INTERVENTIONS ▪ Alcohol cessation, dietary modifications (low-fat) 350 OSMOSIS.ORG Figure 40.4 The histological appearance of pancreatic fat necrosis in a case of severe pancreatitis.

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Pancreatitis essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Pancreatitis by visiting the associated Learn Page.