Acute pancreatitis

Question 1

what are the two most common causes of acute pancreatitis?

Answer 1

gallstones and alcohol misuse

Question 2

where does the pain tend to localise in acute pancreatitis?

Answer 2

upper quadrant/epigastric sometimes radiates to flanks

Question 3

what makes the pain worse in acute pancreatitis? What makes it better?

Answer 3

movement, alleviated by moving forward or assuming the foetal position

Question 4

What sort of pain would be present if there are gallstones in acute pancreatitis?

Answer 4

knife-like sudden pain, worse after food

Question 5

the character of pain in alcohol-induced acute pancreatitis?

Answer 5

less abrupt onset and poorly localised

Question 6

what are the symptoms of acute pancreatitis besides upper abdominal pain?

Answer 6

nausea
vomiting
anorexia
fever

Question 7

what is the name of ecchymosis around the umbilicus? Which disease does it implicate?

Answer 7

Cullen’s sign, acute pancreatitis

Question 8

what is the name of ecchymosis around the flanks? Which disease does it implicate?

Answer 8

Grey turner’s sign, acute pancreatitis

Question 9

which enzymes are increased in acute pancreatitis?

Answer 9

amylase

lipase

Question 10

which enzyme is increased in gallstone causes of pancreatitis?

Answer 10

alanine transaminase (ALT) >150 U/L

Question 11

what will the WBCC of someone with acute pancreatitis look like?

Answer 11

raised, especially neutrophils

Question 12

what will happen to glucose and CRP in acute pancreatitis?

Answer 12

Increase

Question 13

in acute pancreatitis, what are u&Es likely to show?

Answer 13

dehydration due to vomiting

Question 14

what happens to calcium in acute pancreatitis?

Answer 14

hypocalcaemia

Question 15

Which initial imaging would you do on a patient with acute pancreatitis?

Answer 15

USS

Question 16

what would you look for on an abdominal x-ray in a patient with suspected acute pancreatitis and why?

Answer 16

sentinal loop sign - dilated proximal loop secondary to inflammation

Question 17

what would you look for on a chest x-ray in a patient with suspected acute pancreatitis and why?

Answer 17

pleural effusion and signs of ARDS

Question 18

what would you look for on a CT scan in a patient with suspected acute pancreatitis and why?

Answer 18

pancreatic oedema and swelling, non-enhancing necrosis

Question 19

What are the glasgow criteria for pancreatitis?

Answer 19

PaO2 <8kPa
Age >55
Neutrophils > 15x109/L
Calcium <2mmol/L
Renal function - urea >16mmol/L
Enzymes - LDH >600iU/L AST >2000iU/L
Albumin <32g/L
Sugar - glucose >10mmol/L

Question 20

What is the medical and supportive management for acute pancreatitis?

Answer 20

IV fluid resus + ABs
Oxygen
Analgesia
Catheterisation
Parenteral feeding if unable to tolerate oral intake

Question 21

What is the surgical management for acute pancreatitis?

Answer 21

Percutaneous or endoscopic drainage of pancreatic collections
ERCP and cholecystectomy - gallstones cause
Surgical management of other complications eg. necrosectomy if necrotic tissue

Question 22

What are the complications of acute pancreatitis?

Answer 22

Necrosis
pseudocyst
Abscess
Fistulae
Multi-organ failure
Sepsis
AKI
ARDS
Disseminated intravascular coagulation