Acute Pancreatitis

Question 1

what are the common causes of acute pancreatitis?

Answer 1

• alcohol
• gallstones

Question 2

what is the pathophysiology of acute pancreatitis?

Answer 2

1. autodigestion of pancreatic tissue by pancreatic enzymes
2. necrosis

Question 3

what are the features of acute pancreatitis?

Answer 3

• severe epigastric pain that may radiate through to the back
• vomiting

Question 4

what is seen on examination in acute pancreatitis?

Answer 4

• epigastric tenderness
• ileus
• low-grade fever
• cullen’s sign
• grey-turner’s sign

Question 5

what is cullen’s sign?

Answer 5

periumbilical discolouration

‘got really drunk with edward cullen and he tried to do a body shot from your belly but he ended up biting you and you got a big bruise’ = periumbilical discolouration in acute pancreatitis

Question 6

what is grey-turner’s sign?

Answer 6

flank discolouration

‘meridith GREY struts so much she gets bruising on her sides’ = flank discolouration

Question 7

what investigations should be done in acute pancreatitis?

Answer 7

• serum amylase
• serum lipase
• imaging

Question 8

what happens to serum amylase in acute pancreatitis?

Answer 8

• >3x the upper limit of normal
• does not correlate with disease severity

Question 9

what are the causes for raised amylase?

Answer 9

• acute pancreatitis
• pancreatic pseudocyst
• mesenteric infarct
• perforated viscu
• acute cholecystitis
• diabetic ketoacidosis

Question 10

when is serum lipase particularly useful in acute pancreatitis?

Answer 10

late presentation
longer half-life than amylase so useful in presentations >24 hours delayed

Question 11

what imaging can be done in acute pancreatitis?

Answer 11

• early ultrasound - assess aetiology
• contrast-enhanced CT

Question 12

what factors indicate severe pancreatitis?

Answer 12

• age >55 years
• hypocalcaemia
• hyperglycaemia
• hypoxia
• neutrophilia
• elevated LDH and AST

Question 13

what is the most sensitive blood test for diagnosing acute pancreatitis?

Answer 13

serum lipase

Question 14

how is severe acute pancreatitis classified?

Answer 14

persistent (>48 hours) organ failure

Question 15

what is the key aspect of acute pancreatitis management?

Answer 15

fluid resuscitation
aggressive early hydration with crystalloids

Question 16

what urine output should you aim for when managing acute pancreatitis?

Answer 16

> 0.5 mls/kg/hr

Question 17

how is acute pancreatitis managed?

Answer 17

• fluid resuscitation
• analgesia

Question 18

what analgesia is given in acute pancreatitis?

Answer 18

IV opioids

Question 19

what nutrition advise should you give a patient with acute pancreatitis?

Answer 19

**enteral nutrition ** if moderate or severe acute pancreatitis within 72 hours of presentation

Question 20

true or false

all acute pancreatitis should be nil-by mouth

Answer 20

false!
unless there is a clear reason e.g. vomiting

Question 21

surgical management

acute pancreatitis due to gallstones

Answer 21

early cholecystectomy

Question 22

surgical management

acute pancreatitis due to gallstones which has lead to an obstructed biliary system

Answer 22

early ERCP

Question 23

surgical management

infected necrosis

Answer 23

radiological drainage or surgical necrosectomy