Acute and chronic pancreatitis in pregnancy TOG 2021

Question 1

Incidence of acute pancreatitis in pregnancy?

Answer 1

Very rate 3/10,000

Question 2

Causes of pancreatitis

Answer 2

Gallstones - 50%
ETOH 25%

Other: Hypertriglyceridaemia, idiopathic, drug induced (thiazides), hyperemesis gravidarum, acute fatty liver, hyperparathyroid, gene mutation, HELLP

Question 3

Maternal mortality with acute pancreatitis?

Answer 3

3%

Question 4

Symptoms of acute pancreatitis

Answer 4

Sudden onset upper abominal pain/epigastrium radiating to back
Anorexia
N+V

Question 5

Signs acute pancreatitis?

Answer 5

Epigastric tenderness
Reduced bowel sounds
Fever - 2nd SIRS
Tachycardia

Question 6

How common development necrosis of pancreatic tissue

Answer 6

5-10%, worse outcome

Question 7

How to Dx pancreatitis

Answer 7

Need 2 of 3

1) Symptoms
2) Serum amylase/lipase 3 x upper limit normal >300
3) Features of pancreatitis on imaging

Question 8

Imaging of pancreas in pregnancy

Answer 8

1st USS

After 5 day consider
MRI without gadolinium contrast.
CT
if concerned with complications

Question 9

What score is used to determine risk of developing severe pancreatitis

Answer 9

Modified Glasgow Score
>3 considered at risk

Question 10

Describe Modified Glasgow Scoring system

Answer 10

Score 1 point for each parameter present. A score of 3 or more puts the patient at risk of severe pancreatitis4, 5

P – Arterial oxygen saturation (PaO2) <8 kPa

A – Age >55 years

N – Neutrophils white cell count >15 x 109/L

C – Calcium <2.0 mmol/L

R – Raised urea >16 mmol/L

E – Enzymes: lactate dehydrogenase >600 μ/L

A – Albumin <32 g/L

S – Sugar glucose >10 mmol/L

Question 11

Management of pancreatitis

Answer 11

1 IVI
2 Analgesia
3 VTE prophylaxis
4 Nutrition
5 Refer to critical care
6 Abx if proven infection (not initial)
7 Image for complications
8 Treatment of complications
9 Modify risk factors - lap cholecystectomy, lipid, ETOH reduction

Question 12

If pancreatitis caused by gallstones when shuold cholecystectomy occur?

Answer 12

During admission or within 2 weeks of DC at 12-24 weeks
Or after delivery

Question 13

How does pancreatitis effect pregnancy outcomes?

Answer 13

Increased risk preterm birth 15-32%
Fetal mortailirt in severe cases 3.6%