GASTRO/GENSURG
PANCREATITIS
Stems had mild LFT derangment (ALP/AST 300’s) and elevated lipase (500’s)
Prompt
ResponseOedematous pancreas
Heterogenous area ? necrosis
Fat stranding around pancreas
Free fluid in paracolic gutter (R) and perisplenic fluid (L)
Heterogenous area ? necrosis
Fat stranding around pancreas
Free fluid in paracolic gutter (R) and perisplenic fluid (L)
PromptList potential aetiologies of pancreatitis
ResponseI GET SMASHED
Idiopathic
Gallstones
EtOH
Traumatic
Steroids
Mumps
Autoimmune
Scorpion stings
Hypertrigliceridaemia/Hyperlipidaemia/Hypercalcaemia
ERCP
Drugs/medications (Aothiaprine, septrin)
Other:
Sphincter of oddi dysfunction
Malignancy - Pancreatic adenocarcinoma, lymphoma
Postoperative
Idiopathic
Gallstones
EtOH
Traumatic
Steroids
Mumps
Autoimmune
Scorpion stings
Hypertrigliceridaemia/Hyperlipidaemia/Hypercalcaemia
ERCP
Drugs/medications (Aothiaprine, septrin)
Other:
Sphincter of oddi dysfunction
Malignancy - Pancreatic adenocarcinoma, lymphoma
Postoperative
PromptList 1 biochemical severity scoring systems with criteria
ResponseRanson’s (>3 is severe)
Glasgow (>3 is severe)
You had to list 4 points from either score. See below
Glasgow (>3 is severe)
You had to list 4 points from either score. See below
PromptPredictors of severity
ResponsePANCREAS (Mnemonic for Glasgow score - I think)
PAO2 <60 mm.Hg
Age >55
Neutrophilia WCC >15
Calcium <2mmol/L
Renal (Urea >16)
Enzymes (LDH >600, AST >200)
Albumin <32
Sugar >10
PAO2 <60 mm.Hg
Age >55
Neutrophilia WCC >15
Calcium <2mmol/L
Renal (Urea >16)
Enzymes (LDH >600, AST >200)
Albumin <32
Sugar >10
PromptRansons score
ResponseDone at arrival and 48 hours
Arrival criteria:
Age >55
WCC >16
BSL >10
LDH >350
AST >250
4 or 5 is severe - Should go to ICU
Arrival criteria:
Age >55
WCC >16
BSL >10
LDH >350
AST >250
4 or 5 is severe - Should go to ICU
PromptComplications of pancreatitis (local and systemic)
ResponseLocal
Pancreatic pseudocyst
Abscess
Ileus
Portal/Splenic vein thrombosis
Duodenal obstruction
Acute pancreatitis >> Chronic pancreatitis
Systemic
Shock/SIRS
Hypocalcaemia
Metabolic acidosis
Pleural effusion
ARDS
Multi organ failure
Third spacing and hypovolaemia
Pancreatic pseudocyst
Abscess
Ileus
Portal/Splenic vein thrombosis
Duodenal obstruction
Acute pancreatitis >> Chronic pancreatitis
Systemic
Shock/SIRS
Hypocalcaemia
Metabolic acidosis
Pleural effusion
ARDS
Multi organ failure
Third spacing and hypovolaemia