Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Inflammation of the pancreas, usually caused by auto digestion.

Question 2

What is autodigestion?

Answer 2

when the pancreatic enzymes are activated and digest the pancreas.

Question 3

What exocrine functions does the pancreas have?

Answer 3

Exocrine - acinar cells secrete digestive enzymes secreted into the duodenum.

Question 4

What endocrine function does the pancreas have?

Answer 4

alpha and beta cells secrete insulin and glucagon into the blood stream

Question 5

What are symptoms of acute pancreatitis?

Answer 5

Intense epigastric pain (may radiate to the back) 
Hypocalcaemia
nausea
vomiting
Cullens sign (bruising of belly button)
Grey Turners sign (bruising of flank)
Low grade fever 
Tachycardia
Abdominal tenderness

Question 6

What is the difference between acute and chronic pancreatitis?

Answer 6

Acute - Rapid onset inflammation and symptoms. After episode, normal function returns.

Chronic - Longer term inflammation with a progressive and permanent deterioration of pancreatic function.

Question 7

What are the MAIN causes of acute pancreatitis?

Answer 7

Alcohol

Gallstones

Question 8

What are the other causes of acute pancreatitis?

Answer 8

I GET SMASHED:
Idiopathic 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hyercalcaemia + Hyperlipidaemia
ERCP
Drugs

Question 9

which drugs commonly cause acute pancreatitis?

Answer 9

Furosemide (diuretic)
Azathioprine (immunosuppressant)
Thiazide diuretics

Question 10

What investigations can be done?

Answer 10

Serum amylase 
erum Lipase 
Clinical signs
CRP
FBC
U and Es
LFT
Calcium
ABG
Ultrasound (ultrasound)

Question 11

What correlates to a positive diagnosis of acute pancreatitis?

Answer 11

Clinical signs + amylase or lipase >3x the upper limit of normal.

Question 12

What signs suggest a more severe acute pancreatitis?

Answer 12

> 55yrs
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
Elevated LDH
Elevated AST

Question 13

Which enzyme is most specific to pancreatitis?

Answer 13

Lipase > amylase

Question 14

How many people have increased serum amylase?

Answer 14

> 75% of people with acute pancreatitis.

The levels of amylase DO NOT correlate to the severity of the disease.

Question 15

What must the amylase level be for pancreatitis?

Answer 15

Acute = >3x the upper limit of normal.

Chronic - amylase levels might not be increased since the pancreas ends up with reduced function.

Question 16

Who is more likely to have alcohol induced acute pancreatitis?

Answer 16

Young Males

Question 17

Who is more likely to have gallstone induced acute pancreatitis?

Answer 17

Women

Older patients

Question 18

What score can be used to determine how severe the acute pancreatitis is?

Answer 18

Glasgow score
Mild = 0/1
Moderate = 2
Severe = 3 or over

Question 18

What score can be used to determine how severe the acute pancreatitis is?

Answer 18

Glasgow score
Mild = 0/1
Moderate = 2
Severe = 3 or over

Question 19

What is the management of acute pancreatitis?

Answer 19

IV fluids
NIL by mouth
Analgesia

Question 20

When should antibiotics be given?

Answer 20

For necrosis or abscess

Question 21

What is the treatment for gallstones?

Answer 21

ERCP

Question 22

How long does acute pancreatitis usually take to get better?

Answer 22

3-7 days

Question 23

What are the complications of acute pancreatitis?

Answer 23

Necrosis
infection
abscess
DIC
pseudocysts
chronic pancreatitis

Question 24

What are the signs of a pseudocyst?

Answer 24

can develop 4 weeks later
abdominal pain
loss of apetite
palpable mass

Question 25

When should a CT abdomen be done?

Answer 25

Only when complications are suspected - pseudocyst, necrosis, fluid collection, abscess