3. Acute Pancreatitis

Question 1

What is pancreatitis?

Answer 1

Inflammation of the pancreas where pancreatic enzymes (amylase/lipase) attack the pancreatic tissue

Question 2

What is the pain like in pancreatitis?

Answer 2

Epigastric pain that radiates to the back

Question 3

How is pancreatitis clinically diagnosed?

Answer 3

• A rise in amylase more than 3 times the normal amount

- CT scan

Question 4

Why will amylase not rise sometimes in an acute exacerbation of chronic pancreatitis?

Answer 4

Because of the constant damage to the pancreas, it has lost it’s ability to produce the amylase enzyme

Question 5

What are the causes of acute pancreatitis?

Answer 5

I : Idiopathic

G : Gallstones
E : Ethanol
T : Trauma

S : Steroids
M : Mumps / Malignacy
A : Autoimmune
S : Scorpion venom
H : hyperlipidaemia/hypercalcaemia/hyperparathyroidism
E : ERCP
D : drugs (tetracyclines, furosemide, azathioprine, thiazides and many others)

Question 6

What does ERCP stand for?

Answer 6

Endoscopic Retrograde Cholangio-Pancreatography

Question 7

How is pancreatitis graded?

Answer 7

It is graded using the ‘Glasgow Score’.
Mild : 0-1
Moderate : 2
Severe : 3+

Question 8

What conditions cause you to get a point on the Glascow score for pancreatitis?

Answer 8

P 	– 	Pa02 < 60
A 	–	Age > 55
N 	– 	Neutrophils (WBC > 15)
C 	– 	Calcium < 2
R 	– 	uRea >16
E 	– 	Enzymes (LDH > 600 or AST/ALT >200)
A 	– 	Albumin < 32
S 	– 	Sugar (Glucose >10)

Question 9

What are the complications for acute pancreatitis?

Answer 9

• Pancreatic necrosis
• Infection in necrotic areas
• Pseudocysts
• Chronic pancreatitis

Question 10

How should you manage someone with acute pancreatitis?

Answer 10

• Escalate care according to Glasgow Score, as patients can become extremely sick very quickly
• IV fluids
• Analgesia
• Endoscopic drainage of large pseudocysts
• Antibiotics only if evidence of infected pancreatic necrosis
• Surgery to remove infected pancreatic necrosis