12. Acute pancreatitis

Question 1

Definition of acute pancreatitis ?

Answer 1

Is a common nonbacterial inflammatory disease caused by activation, interstitial liberation, and autodigestion of the pancreas by its own enzymes.

Question 2

What is the most common causes of acute pancreatitis ?

Answer 2

• Biliary tract disease (Gallstones passing into the bile duct and temporarily blocking the sphincter of Oddi). (approx. 38%)

Question 3

Clinical signs ? pain ?

Answer 3

• Mild to severe epigastric pain, with radiation to the flank, the back, or both.
• The pain is dull and boring, and is worse when the patient is supine.
• A heavy meal or drinking are often triggers for the pain.

Question 4

Physical examination of acute pancreatitis ?

Answer 4

• Abdominal tenderness.
• Fever.
• Muscular guarding.
• Tachycardia.
• Distension.
• Bowel sounds often are hypoactive.
• A minority of pts have jaundice.

Question 5

Physical findings associated with severe necrotizing pancreatitis: ?

Answer 5

• The Cullen sign.
• The Grey-Turner sign.
• Erythematous skin nodules.
• The Clermont sign.

Question 6

Lab studies Amylase and Lipase ?

Answer 6

• Serum amylase and lipase typically are elevated in pts with acute pancreatitis.
• Amylase levels > 3x normal very suggestive of pancreatitis.

Question 7

Lab Studies: Lipase?

Answer 7

▫ More sensitive & specific than amylase.

▫ Lipase is more typical for alcohol related AP.

Question 8

Elevations of amylase can occur also in patients with a:

Answer 8

▪ small intestinal obstruction.
▪ Gastrointestinal perforation 
▪ mesenteric ischemia.
▪ tuboovarian disease.
▪ renal insufficiency.
▪ parotitis - rarely.

Question 9

Sentinel loop
 ?

Answer 9

Sentinel loop refers to a segment of intestine that becomes paralyzed and dilated as it lies next to an inflamed intra abdominal organ.

Question 10

Imaging Studies of acute pancreatitis ?

Answer 10

• Abdominal USG.

the most useful test in determining the etiology of pancreatitis.

Question 11

Prognostic Criteria of acute pancreatitis is acc. to ?

Answer 11

Ranson.