Acute Pancreatitis

Question 1

ESSENCE

Answer 1

Refers to inflammation of pancreas

Acute refers to rapid onset of symptoms, after an episode normal function usually returns

Question 2

AETIOLOGY

Main causes

Answer 2

• 3 main causes
  
  • Gallstones
  • Alcohol
  • Post-ERCP

Question 3

AETIOLOGY

Long list cause mneumonic

Answer 3

• Remember I GET SMASHED
  
  • Idiopathic
  • Gallstones
  • Ethanol (alcohol)
  • Trauma
  • Steroids
  • Mumps
  • Autoimmune
  • Scorpion sting
  • Hyperlipidaemia
  • ERCP
  • Drugs (furosemide, thiazide diuretics and azathioprine)

Question 5

AETIOLOGY

Main drugs

Answer 5

• Steroids
• Furosemide
• Thiazide diuretics
• Azathioprines

Question 6

CLINICAL FEATURES

Presentation

Answer 6

• Acute onset of
  
  • Severe epigastric pain
  • Radiates through to back
  • Associated vomiting
  • Abdominal tenderness
  • Systemically unwell (eg low grade fever and tachycardia)

Question 7

INVESTIGATIONS

First choice

Answer 7

• Mainly clinical diagnosis plus amylase level
• Typical acute abdomen investigations
• Amylase
• C-reactive protein - monitor inflammation
• US - initial investigation of choice for assessing gallstones
• CT abdomen - assess complications

Question 8

What are typical investigations required for any acute abdomen case

Answer 8

• Needs to include those for Glasgow score
  
  • FBC
  • U&E
  • LFT (for transaminases and albumin)
  • Calcium
  • ABG (for PaO2 and blood glusoe)

Question 9

Describe Glasgow score

Answer 9

• Used to assess severity of pancreatitis, gives numerical score based on how many of key criteria are present
  
  • 0/1 - mild
  • 2 - moderate
  • 3 - severe

Question 10

What is the critiera for Glasgow score

Answer 10

• Remember PANCREAS
  
  • PaO2 < 8kPa
  • Age > 55
  • Neutrophils (WBC > 15)
  • Calcium < 2
  • uRea > 16
  • Enzymes (LDH > 600 or AST/ALT > 200)
  • Albumin < 32
  • Sugar (glucose > 10)

Question 11

MANAGEMENT

General principles

Answer 11

• Can become rapidly unwell so require admission to supportive management, moderate or severe cases considered for HDU or ICU
• Initial resuscitation (ABCDE approach)
• IV fluids
• Nil by mouth
• Analgesia
• Careful monitoring
• Treatment of gallstones maybe
• Antibiotics if evidence of infection
• Treatment of complications

Question 12

COMPLICATIONS

Answer 12

• Necrosis of pancreas
• Infection in necrotic area
• Abscess formation
• Acute peripancreatic fluid collection
• Pseudocysts (collections of pancreatic juice)
• Chronic pancreatitis