Acute and Chronic Pancreatitis

Question 1

What is Acute Pancreatitis?

Answer 1

Inflammation of the pancreas over a short period of time

Question 2

What are the risk factors of Acute Pancreatitis?

Answer 2

• Family history
• Smoking
• Excessive alcohol consumption
• Obesity
• Gallstones

Question 3

What are the clinical features of Acute Pancreatitis?

Answer 3

• Fever
• Vomiting
• Tachycardia
• Jaundice
• Sudden or gradual epigastric pain (relieved when sitting upright)
• Periumbilical bruising

Question 4

What is the differential diagnosis of Acute Pancreatitis?

Answer 4

• Oesophageal spasm
• AAA
• Peptic Ulcer disease
• Cholangitis
• Intestinal obstruction
• Cholecystitis

Question 5

What is the differential diagnosis of severe abdominal pain?

Answer 5

• AAA
• Peptic Ulcer Disease
• IBS
• Pregnancy

Question 6

What are the causes of Acute Pancreatitis?

Answer 6

=> Mnemonic GET SMASHED

G - Gallstones
E - Ethanol (Alcohol)
T - Trauma

S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion venom
H - Hyperlipidemia
E - ERCP
D - Drugs - steroids, Sodium Valporate 

=> Gallstones and alcohol are the 2 most common causes

Question 7

What is the pathophysiology of Acute Pancreatitis?

Answer 7

Auto-digestion of pancreatic tissue by pancreatic enzymes leading to necrosis

Proteases causes damage to cells and vasculature
Lipases cause fatty necrosis of pancreas
Amylase levels increase in blood

Question 8

What are the investigations in suspected Acute Pancreatitis?

Answer 8

=> Serum Amylase and Lipase (1st line)

• Amylase must be 3 time higher than upper limit
• Not specific or indicator of severity
• Lipase more specific (1st)

=> ABG

=> AXR or CXR

• No psoas shdow on AXR
• CXR excludes differentials

=> CT
Used to determine severity

=> Ultrasound
- Assessing for gallstones

Question 9

What is the management of Acute Pancreatitis?

Answer 9

• IV Analgesics
• Nutrition provided through enteral feeding, NG tube or IV
• Give lots of crystalloids
• Early cholecystectomy in cases of gallstones
• Early ERCP for those with obstructed biliary system
• Antibiotic therapy

Question 10

What is used to predict the severity of Acute Pancreatitis?

Answer 10

P - PaO2 < 8kPa
A - Age < 55
N - Neutrophilia (WBC > 15 x 10^9)
C - Ca (< 2 mmol/L)
R - Renal function (Urea > 16 mmol/L)
E - Enzymes
A - Albumin (< 32 g/L)
S - Sugar (>10 mmol/L)

3 or more of above within 48 hours indicates severe pancreatitis

Question 11

What is Chronic Pancreatitis?

Answer 11

Inflammatory condition which affects the exocrine and endocrine functions of the pancreas. Characterised by recurrent or persistent abdominal pain

Question 12

What are the risk factors of Chronic Pancreatitis?

Answer 12

• Long term alcohol consumption
• Gallstones
• High fat diet

Question 13

What are the clinical features of Chronic Pancreatitis?

Answer 13

• Loss of weight
• Erythema ab igne (skin condition)
• Bloating
• Epigastric pain (typically at worst 15 to 20 mins after meal)
• Diabetes
• Steatorrhoea

Question 14

What is the differential diagnosis of Chronic Pancreatitis?

Answer 14

• Acute Pancreatitis
• Pancreatic Carcinoma
• Peptic Ulcer Disease
• AAA
• MI

Question 15

What are the causes of Chronic Pancreatitis?

Answer 15

=> Genetic causes:

• Cystic fibrosis
• Haemochromatosis

=> Ductal obstruction:

• Tumours
• Stones
• Structural abnormalities: pancreas divisum, annular pancreas

Question 16

What are the investigations in suspected Chronic Pancreatitis?

Answer 16

=> AXR
Pancreatic calcification

=> CT with IV contrast (1st line)
More sensitive than AXR

=> MRCP, ERCP

Question 17

What is the management of Chronic Pancreatitis?

Answer 17

• Pancreatic enzyme supplements
• Analgesia
• Antioxidants - beneficial in early disease