Acute Pancreatitis

Question 1

What is the underlying pathophysiology of acute pancreatitis?

Answer 1

Disorder of the exocrine pancreas. Pancreatic enzyme mediated auto digestion, oedema and fluid shifts causing hypovolaemia as extracellular fluid is trapped in the peritoneum and retroperitoneum.

Question 2

What percentage of cases of acute pancreatitis are mild, and what percentage develop severe disease?

Answer 2

1. 80% are mild, 20% develop severe complicated and life-threatening disease.
2. Progression maybe rapid from mild oedema to necrotising pancreatitis.

Question 3

What are the causes of acute pancreatitis?

Answer 3

GET SMASHED
G - gallstones
E - alcohol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion venom
H - hyperlipidaemia, hypercalcaemia, hypothermia
E - ERCP
D - drugs

Question 4

What is this a presentation of?
Gradual or sudden severe epigastric or central abdominal pain which radiates to the back. Nausea, vomiting, anorexia, tachycardia, tachypnoea, hypotension, fever, jaundice, rigid abdomen, periumbilical or flank bruising.

Answer 4

Acute pancreatitis

Question 5

What is the difference between Cullen’s and Grey Turner’s signs, what condition do they indicate?

Answer 5

1. Cullen’s - periumbilical bruising
2. Grey Turner’s - flank bruising
3. Acute pancreatitis

Question 6

How is acute pancreatitis investigated?

Answer 6

1. Serum amylase (>1000U/ml)/lipase (more specific)
2. Early and serial CRP
3. ABG for oxygenation
4. FBC shows high WCC
5. AXR - no psoas shadow and sentinel loop, erect CXR - exclude perforation.
6. Abdominal USS how to diagnose cause if gallstones and raised ALP.

Question 7

What is the modified Glasgow score used for, what are the factors, and how many criteria must be reached for a referral to ITU?

Answer 7

1. Assessing severity of acute pancreatitis
2. PaO2 <7.9, age >55, WCC >15, calcium <2mmol/L, urea >16mmol/L, LDH >600IU/L, serum albumin <32g/L, blood glucose >10mmol/L.
3. 3 or more factors within 48 hours

Question 8

What is the management for acute pancreatitis?

Answer 8

1. Vigorous IV fluids, catheterise to monitor output.
2. Kept NBM until abdominal pain and vomiting improve, NJ tube to avoid pancreatic stimulation.
3. Strong analgesia and antiemetic
4. Cholecystectomy/ERCP if gallstones are the cause.

Question 9

What are the early and late complications of acute pancreatitis?

Answer 9

Early - shock, renal failure, sepsis, hypocalcaemia, hyperglycaemia, DIC.
Late - pancreatic necrosis, bleeding from elastase eroding major vessels, thrombosis, abscesses, pseudocysts.