Abdominal pain & pancreatitis

Question 1

Define acute and chronic pancreatitis.

Answer 1

Acute pancreatitis - endocrine/exocrine function of the pancreas and its structure returns to normal after he episode of pancreatitis
Chronic pancreatitis - permanent structural changes occur and pancreatic function is permanently damaged

Question 2

Recall the causes of acute pancreatitis.

Answer 2

Gallstones
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion Venom 
Hyperlipidaemia/Hypercalcaemia
ERCP 
Drugs

Question 3

State some symptoms and signs of acute pancreatitis. Name the specific signs.

Answer 3

Epigastric pain radiating to the back
Nausea and vomiting
Patient acutely unwell and in shock
May have organ failure
May be evidence of jaundice/cholangitis
Grey Turner’s Sign - ecchymoses on the flanks (lateral abdominal wall)
Cullen’s Sign - ecchymoses below the umbilicus

Question 4

List some blood tests and imaging modalities that are useful for patients with pancreatitis.

Answer 4

Elevated pancreatic enzymes (amylase/lipase)
Lipase remains elevated longer and is more specific of pancreatitis but it isn’t normally measured
Radiological:
Chest X-ray to eliminate possibility of perforated ulcer
Abdominal X-ray - eliminate the possibility of local ileus
CT - if there is any diagnostic doubt

Question 5

Recall three causes of chronic pancreatitis.

Answer 5

Alcohol excess
Microlithiasis
Idiopathic
Rarer causes: hereditary, hyperparathyroidism

Question 6

What would you expect the amylase and lipase levels of a patient with chronic pancreatitis to be and why?

Answer 6

Normal - due to loss of pancreatic enzyme function

Question 7

Recall the complications of acute and chronic pancreatitis.

Answer 7

Systemic:
Hypovolaemia (dehydration) 
Hypoxia (unable to breathe deeply because of upper quadrant pain) 
Hypocalcaemia 
Hyperglycaemia 
DIC 
Multiple Organ Failure 

Local:
Pancreatic necrosis
Fluid collections - mature into pseudocysts
Splenic vein thrombosis/pseudoaneurysm

Question 8

What is the vertebral level of the pancreas?

Answer 8

L1/L2

Question 9

Acute and chronic pancreatitis can be further classified on the basis of what?

Answer 9

Aetiology

Pathology

Question 10

At what level does pancreatic amylase have to be to be diagnostic of pancreatitis?

Answer 10

3 x upper border of normal

Question 11

Name three scoring systems used for pancreatitis.

Answer 11

Modified Glasgow Scale
Ranson Scale
Apache II

Question 12

How would you treat the complications of someone with acute pancreatitis?

Answer 12

Rehydrate
Interventional radiology - embolisation of haemorrhage and drainage of abscess
Surgical - cholecystectomy, necrosectomy, drainage of pseudocyst