**ACC (Y4)** Abdominal: Acute and Chronic Pancreatitis

Question 1

which region of the abdomen would you palpate the pancreas?

Answer 1

epigastric region

Question 2

which cells of the pancreas secrete digestive enzymes?

Answer 2

acinar cells

Question 3

what does the pancreas secrete to protect itself from its own digestive enzymes?

Answer 3

pro-enzymes or zymogens

Question 4

what is acute pancreatitis?

Answer 4

characterized by distinct episodes of acute pancreatitis with full recovery between episodes

Question 5

what is chronic pancreatitis?

Answer 5

Chronic pancreatitis is a chronic, irreversible, inflammation and/or fibrosis of the pancreas

Question 6

what are the most common causes of acute pancreatitis?

Answer 6

gallstones or alcohol misuse

Question 7

which type of people are infected more by pancreatitis? males or females?

Answer 7

Acute: males and females equally.

Chronic: males>females 4:1.

Question 8

What are some risk factors of pancreatitis?

Answer 8

• Gall stones.
• Alcohol misuse.
• Endoscopic procesdures.
• Blunt abdominal trauma.
• Surgery near the pancreas.
• Metabolic conditions hypertriglyceridaemia and hypercalcaemia
• Infections such as mumps, coxsackie B4 virus, and Mycoplasma
  pneumonia infection.
• IBD.
• Smoking.
• Obesity.
• Family history.

Question 9

how is mild acute pancreatitis characterised?

Answer 9

characterized by the absence of complications (local or systemic) or organ dysfunction. It usually has an uneventful recovery.

Question 10

how is moderately severe pancreatitis characterised?

Answer 10

characterized by local complications and/or transient organ dysfunction which resolves within 48 hours.

Question 11

how is severe pancreatitis characterised?

Answer 11

characterized by persistent organ dysfunction (failure to resolve in 48 hours) and often leads to local complications such as pancreatic necrosis, abscess, and pseudocyst formation.

Question 12

What is the pain associated with pancreatitis described as?

Answer 12

• generalised abdominal pain

- pain may radiate to the back, may be relieved by sitting up/leaning forward

Question 13

what may alleviate the pain associated with pancreatitis?

Answer 13

relieved by sitting up/leaning forward

Question 14

what are some clinical features of pancreatitis?

Answer 14

• generalised abdominal pain which may radiate to the back
• nausea, vomiting
• bloating
• weight loss
• steatorrhoea
• jaundice
• signs of chronic liver disease

Question 15

what is steatorrhoea?

Answer 15

the excretion of abnormal quantities of fat with the faeces owing to reduced absorption of fat by the intestine

Question 16

how is the pain associated with pancreatitis different, if caused by gallstones?

Answer 16

• pain is sudden and knife like

- pain often starts after a large meal

Question 17

how is the pain associated with pancreatitis different, if caused by alcohol?

Answer 17

• pain may be of less abrupt onset

- poorly localized

Question 18

which conditions present in a similar way to acute pancreatitis?

Answer 18

• Perforated peptic ulcer, bowel obstruction, or ischaemic bowel.
• Ruptured abdominal aortic aneurysm.
• Myocardial infarction.
• Biliary colic, acute cholecystitis, or cholangitis.
• Viral hepatitis.
• Gastroenteritis.

Question 19

which conditions present in a similar way to chronic pancreatitis?

Answer 19

• Acute cholecystitis, biliary colic.
• Acute pancreatitis.
• Irritable bowel syndrome.
• Peptic ulcer disease.
• Post-herpetic neuralgia.
• Gastroparesis.
• Internal obstruction, ischaemia or infarction.
• Abdominal aortic aneurysm.
• Thoracic radiculopathy.
• Myocardial infarction.

Question 20

what may make the pain associated with pancreatitis worse?

Answer 20

movement (that’s not the fetal position)

Question 21

what should you examine for when presented with suspected pancreatitis?

Answer 21

• Abdominal tenderness.
• Abdominal distension.
• A bluish discolouration around the umbilicus
  (Cullen’s sign); or the flank (Grey-Turner’s sign) is sometimes associated with haemorrhagic pancreatitis (a late, serious complication).
• Tachycardia and hypotension — caused by shock.

Question 22

what is Cullen’s sign?

Answer 22

A bluish discolouration around the umbilicus associated with haemorrhagic pancreatitis

Question 23

what is Grey Turner’s sign?

Answer 23

A bluish discolouration around the flank of abdomen associated with haemorrhagic pancreatitis

Question 24

What investigations will be carried out in secondary care for pancreatitis?

Answer 24

• Blood tests to look for elevated levels of pancreatic enzymes (lipase or amylase levels).
• Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas
  inflammation.
• Abdominal ultrasound to look for gallstones and pancreas inflammation.
• Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct.
• Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts.
• Stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn’t
  absorbing nutrients adequately.

Question 25

What is the treatment for pancreatitis?

Answer 25

admit patient urgently is suspected pancreatitis

• IV fluids
• Oxygen supplements
• Pain relief
• Antibiotics for associated cholangitis or infection
• Nutritional support

Question 26

what are some local complications of acute pancreatitis?

Answer 26

• Pancreatic necrosis (necrotizing pancreatitis) with or without infection.
• Pseudocyst which can be complicated by infection, rupture or haemorrhage.
• Pancreatic abscess.
• Fistulae.
• Vascular complications e.g. pre-hepatic portal
  hypertension, erosion of a pancreatic, splenic or peri- pancreatic artery or vein with haemorrhage.

Question 27

what are some systemic complications of acute pancreatitis?

Answer 27

• Acute renal failure.
• Multiple organ dysfunction.
• Acute respiratory distress syndrome.
• Disseminated intravascular coagulation.
• Sepsis.

Question 28

what are some common complications of chronic pancreatitis?

Answer 28

• Maldigestion and malabsorption (malnutrition).
• Diabetes mellitus.
• Chronic pain.
• Opioid dependency for treatment of chronic pain.
• Low-trauma fracture due to an increased risk of osteoporosis due to malabsorption.
• Pancreatic calcification.
• Pseudocyst formation.