18 - Acute Pancreatitis

Question 1

Presentation of acute pancreatitis?

Answer 1

Sudden onset mid-epigastric or LUQ pain associated with nausea, vomiting, and anorexia
- worse on movement

Question 2

Signs of a systemic inflammatory response?

Answer 2

Tachycardia
Tachypnoea
Fever
Raised inflammatory markers (WCC, CRP)

Question 3

Why is CRP a particularly relevant measure in acute pancreatitis?

Answer 3

Patients with CRP >200 indicate high risk of developing pancreatic necrosis

Question 4

How can pancreatitis be diagnosed without imaging?

Answer 4

Clinical features + serum lipase/amylase

Question 5

When do priority of investigations change in acute pancreatitis and why?

Answer 5

Usually examination + bloods for lipase/amylase is enough for diagnosis

However, if CRP is >200 and thus, patient is at risk of developing pancreatic necrosis, a CT abdomen should be performed to detect complications

Question 6

What is cholelithiasis and choledocholelithiasis?

Answer 6

Cholelithiasis - formation of gallstones

Choledocholelithiasis - presence of gallstones in the bile duct, may have formed there or in the gallbladder itself

Question 7

What can choledocholelithiasis cause and how is it identified as the cause?

Answer 7

Can be a cause of acute pancreatitis

- raised LFTs, especially in the absence of alcohol excess