Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

-acute inflammatory process of the pancreas, involvement of regional tissues or remote organs

• inappropriate activation of trypsinogen to trypsin in the pancreatic cells
• trypsin causes autodigestion of the pancreatic tissue, causing necrosis
• can stimulate inflammatory cytokines, can cause Systemic Inflammatory Response Syndrome
• SIRS can cause ARDS or multiorgan dysfunction syndrome

Question 2

Causes of acute pancreatitis:

Answer 2

1. 70% is alcohol and gallstones.
2. 20% variety of reasons
   - Obstructive (post ERCP, pancreatic cancer, congenital abnormalities- pancreas divisum, Ascariasis in children)

• Metabolic (hypercalcaemia, hyperlipaedimia, hyperparathyroidism, porphyria)
• Drugs ( T.B, ARVs, antibiotics, thiazide diuretics)
• Trauma (blunt, post-operative)
• Autoimmune
• Pregnancy related
• Viral (HIV, mumps)
• Collagen disease

Question 3

Mnemonic for causes of acute pancreatitis:

Answer 3

-I GET SMASHED

I- idiopathic
G=gallstones
E=ethanol
T=trauma

S=Steroids
M=Malignancy, mumps
A=Autoimmune
S=Scorpion sting
H=Hypercalcaemia, hyperlipaedaemia
E=ercp
D=Drugs

Question 4

2 pathological entities recognised:

Answer 4

1. Acute Interstitial Oedematous Pancreatitis

2. Acute necrotising pancreatitis

Question 5

What are the local complications of acute pancreatitis?

Answer 5

A. Collections

1. Acute peripancreatic fluid collection
   - with IOP
   - No necrosis and less than 4 weeks after the onset of IOP, no defined wall
2. Pancreatic Pseudocyst
   - Well defined inflammatory wall
   - Little or no necrosis
   - Greater than 4 weeks from the onset of IOP
   - associated with duct disruption

3.Acute Necrotic Collection

4. Walled-off necrosis
   - Greater than 4 weeks after onset of NP

B. Other organ complications

• Gastric Outlet Dysfunction
• Intestinal necrosis
• Splenic/ Portal Vein thrombosis