Acute Pancreatitis

Question 1

Criteria for acute pancreatitis:

Answer 1

Glasgow-Imrie criteria for severity of acute pancreatitis:

PaO2 <8kPa
Age >55
Neutrophils >15
Calcium <2
Renal, urea >16
Enzymes, LDH >600, AST >2000
Albumin <32
Sugar, glucose >10

Question 2

Airway

Answer 2

the usual

Question 3

Breathing

Answer 3

Look:
Listen:
Feel:

RR, BP
XCR

Question 4

Circulation

Answer 4

Look:
Listen:
Feel:

HR (high as in pain), BP

IV access

Bloods: FBC, UEs, LFTs, CRP, amylase, lipase, calcium, glucose, blood cultures
VBG

Apply Glascow Imrie Criteria
PANCREAS score/ Modified Glasgow >3 requires ITU/HDU

Management:
1. Analgesia pethidine 75-100 mg/ 4h IM, morphine
2. IV fluids
3. TPN/ NG as necessary (enteral feeding is gold standard)
- Do not make NBM unless there is a clear reason for this

Surgical intervention:
ERCP -> remove gallstones If severe: laparotomy/ lavage +/- necrosectomy

Question 5

Important bits

Answer 5

Definitive Ix:
Acute abdo work up do basics and then ring SpR

Defintive Rx:
Analgesia
IV fluids
Consider: surgical SpR to exclude surgical cause
ITU support if severe ≥ 3 on Glasgow score

**Acute abdo work-up:

Bedside: Urinalysis, pregnancy test, ABG

Bloods: For diagnosis: FBC,
CRP, U+E, LFTs, amylase, calcium, glucose, blood cultures

For surgery: G+S, cross match, coagulation

Imaging:
Erect CXR, AXR, USS,
CT abdomen**

Question 6

G&E

Answer 6

Abdo: peritonism, look for bruising around flanks