acute pancreatitis

Question 1

pancreaatitis

Answer 1

inflammation of the pancreas

Question 2

function of the pancreas

Answer 2

exocrine - digestive enzymes, protein breakdown
endocrine - beta cell insulin secretion

Question 3

pancreaas aanatomical location

Answer 3

retroperitoneal

Question 4

pathophysiology of pancreatitis

Answer 4

activation of auto digestion of pancreas
local response: inflammation and pain, oedema and fluid leak, tissue damage and necrosis
systemic response - systemic inflammatory response syndrome, near by organs can be obstructed or paralysed

Question 5

consequences of pancreatitis: activation of inflammatory cascade and cytokines release

Answer 5

acute inflammatory response:
- local vasodilatation and increase permeability
- oedema
- vascular injury and hyper-perfusion
- ischaemia and tissue necrosis

Question 6

SIRS

Answer 6

systemic inflammatory response syndrome
-> systemic release of IL1 and TNFa

Question 7

two pathways for pancreatic injury aand inflammation

Answer 7

trypsinogen activation
NFkB activation

both cause pancreatic injury and inflmmation

Question 8

leading causes of pancreatitis

Answer 8

alcohol
gall stones

Question 9

some other causes of pancreatitis

Answer 9

idiopathic
autoimmune
metabolic (hypertriglyceridemia and hypercalcaemia)
malignancy
ERCP
drug induced
traumatic
viral (mumps, coxsackie B, rarely HIV, Hep)
bacterial (yersinia, salmonella) paarasites (ascaria, liver fluke)

Question 10

to diagnose pancreatitis

Answer 10

needs 2/3 of:
-> pain typical of pancreatitis (aacute onset epigastric maybe radiating to the back)
-> lipase 3x normal value
-> imaging confirming inflammation of the pancreas (can be enough to diagnose pancreatitis on its own)

Question 11

types of pancreaatitis

Answer 11

interstitial oedematous pancreatitis (90%)
necrotising pancreatitis (10%)

Question 12

interstitial oedematous pancreatitis

Answer 12

diffuse gland enlargement
fluid collections around the pancreas (peripancreatic fluid collections)
uniform enhancement of the gland on imaging (necrotising will light up in patches)

Question 13

necrotising pancreatitis

Answer 13

usually involves necrosis of both glang and peripancreatic tissue
needs days to develop and confirm hence CT is unreliable early in course of disease
associated with higher mortality

Question 14

phases of acute pancreatitis

Answer 14

early (one week) - usually relates to SIRS and acute inflammatory process, can have systemic effects and organ failure
late - persistance of systemic complication and organ failure, evolution of local complications and progression

Question 15

types of local complications

Answer 15

necrosis, fluid collection, pseudocysts

Question 16

luminal local complications of pancreatitis

Answer 16

gastric outlet obstruction
colonic stricture
colonic perforation
biliary obstruction

Question 17

vascular local complications of pancreatitis

Answer 17

venous thrombosis
arterial pseudo-aneurysm
heamorrhage (direct or DIC)

Question 18

compartment local complications of pancreatitis

Answer 18

intra-abdominal hypertension and ACS
- psuedo-obstruction
- ileus