Acute pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Rapid onset of inflammation of the pancreas which results in pancreatic enzyme-mediated autodigestion

Question 2

What are the causes of acute pancreatitis?
(GET SMASHED)

Answer 2

G - gallstones
E - ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion venom
H - hyperlipidaemia
E - ERCP
D - drugs i.e. furosemide, thiazide diuretics and azathioprine

Question 3

Name 2 ways acute pancreatitis might present

Answer 3

• Severe epigastric pain radiating through to the back
• Vomiting
• Abdominal tenderness
• Systemically unwell i.e. low-grade fever and tachycardia

Question 4

1) What is raised more than 3 times the upper limit of normal in acute pancreatitis?
2) What else is also raised in acute pancreatitis and is considered more sensitive and specific than the first one?
3) What is the preferred diagnostic imaging modality for acute pancreatitis?

Answer 4

1) Amylase
2) Lipase
3) CT with contrast

Question 5

1) What is the Glasgow score used to asses?
2) What are the 8 criteria in the Glasgow score?
3) A score of what indicates severe pancreatitis?

Answer 5

1) Severity of acute pancreatitis

2)
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

3) 3 or more

Question 6

Name 3 complications of acute pancreatitis

Answer 6

• Necrosis of the pancreas
• Infection in a necrotic area
• Shock
• Abscess formation
• Acute peripancreatic fluid collections
• Pseudocysts (collections of pancreatic juice) can develop 4 weeks after acute pancreatitis
• Acute respiratory distress syndrome
• Chronic pancreatitis
• Renal failure
• Bleeding

Question 7

What is the most important aspect of the initial management of acute pancreatitis?

Answer 7

Aggressive IV fluids

Question 8

What analgesia is normally required to control the pain in acute pancreatitis?

Answer 8

IV opioids

Question 9

Should patients be nil by mouth in the management of acute pancreatitis?

Answer 9

No

Question 10

What nutrition should be offered for patients with acute pancreatitis?

Answer 10

Enteral nutrition 1st line, parenteral second. Only offer if moderate/severe and presentation is within 72 hrs