Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Acinar cell injury w local/ systemic inflamm

Most have mild disease w minimal pancreatic oedema→ recover in few days
Minority have severe disease: persistent systemic inflamm response and/or multi-organ failure, with or without pancreatic necrosis

Question 2

What do acinar cells do?

Answer 2

Functional unit of exocrine pancreas. Synthesizes, stores, and secretes digestive enzymes
(Lipase, trypsin, chymotrypsin, amylase)

Question 3

Aetiology of acute pancreatitis?

Answer 3

• Idiopathic
• Gallstones
• Ethanol/ alcohol
• Trauma
• Steroids
• Mumps (infection, also inclu EBV)/ malignancy
• Autoimmune
• Scorpion bites
• Hyperlipidaemia/ calcaemia
• ERCP
• Drugs

Question 4

Risk factors for acute pancreatitis?

Answer 4

• Middle-aged women
• Young to middle-aged men
• Gallstones and alcohol (main)
• Hypertriglyeridaemia, use of causative drugs, ERCP, trauma, etc

Question 5

Common signs and symptoms of acute pancreatitis?

Answer 5

• Epigastric pain, radiating to back
• Relieved by sitting forward, worsened by movement
• N&V
• Tachycardia
• Fever
• Signs of pleural effusion seen in approx 50%

Question 6

Uncommon signs and symptoms of acute pancreatitis?

Answer 6

Hypocalcaemia (sign of severe dis)
- CATS go NUMB: convulsions, arrhythmias, tetany, numbness
- Chovstek’s signs: facial muscle spasm when tapping facial nerve

Haemorrhagic pancreatitis
- Cullen’s sign: bruising around umbilicus
- Grey-Turner’s: bruising around flanks

Question 7

Ix: Blood test results for acute pancreatitis?

Answer 7

• HIGH AMYLASE + LIPASE (3x upper limit)
• FBC: high WCC
• High CRP: if >200 mg/L, assoc with risk of pancreatic necrosis
• Pulse oximetry: high risk of hypoxaemia
• LFTs: ALT >3x higher predicts gallstones as cause

Question 8

Ix: Investigations (exclu. bloods) for acute pancreatitis?

Answer 8

CT abdo!!

USS (usually not needed for diagnosis): dilated biliary tree
- Confirm/ exclude gallstones
- May show pancreatic inflammation, peri-pancreatic stranding, calcifications, fluid collections

CXR: may show pleural effusions/ atelectasis
Faecal elastase: low in chronic pancreatitis

Question 9

Ix: RANSON criteria for acute pancreatitis?

Answer 9

Assesses severity and mortality of pancreatitis. 5 parameters:
- Age (70 years+)
- WCC
- Blood glucose (>12.2 mmol/L)
- Serum AST
- Serum lactate dehydrogenase

Question 10

Medical management for acute pancreatitis?

Answer 10

Fluid resus
Analgesia
NG tube
Consider: oxygen, anti-emetic, calcium replacement therapy
ABs for necrosis

Question 11

Other management for acute pancreatitis?

Answer 11

• ERCP if gallstone aetiology
• Necrosectomy if necrosis

Question 12

Potential local complications of acute pancreatitis? (4)

Answer 12

• Necrotic pancreatitis
• Haemorrhagic pancreatitis
• Abscess
• Pseudocyst

Question 13

Potential systemic complications of acute pancreatitis?

Answer 13

• Sepsis
• ARDS
• Renal failure
• Hypocalcaemia
• Diabetes