Acute Pancreatitis

Question 1

Define acute pancreatitis.

Answer 1

Question 2

What are causes of acute pancreatitis?

Answer 2

top causes- gallstones, excess alcohol consumption, trauma (ERCP), hypercalcemia, steroids.

Question 3

Describe the pathophysiology of acute pancreatitis and its sequelae.

Answer 3

premature exaggerated activation of enzymes due to bile –>

(A) increased amylase –> lipase –>
1. lipase –> fat digestion –> fat necrosis –> increased fatty acids –> bind to calcium –> hypocalcemia
2. peripancreatic digestion –> invasion –> abscess –> spiking fever –> sepsis
3. vessel digestion –> intraparenchymal or retroperitoneal haemorrhage –> cullen’s or grey turner’s sign

(B) Failure of islets of langerhan –> decreased insulin –> severe hyperglycemia

(C) systemic inflammatory response –> increased global vascular permeability –> fluid shift in the 3rd space (1st space - intracellular, 2nd - extracellular, 3rd - intra and extra peritoneal or anywhere else)

Question 4

What are the common symptoms of acute pancreatitis?

Answer 4

Question 5

What exam findings would you expect to find in acute pancreatitis.

Answer 5

Question 6

What are the ddx for acute pancreatitis?

Answer 6

Question 7

What would you expect to find on CXR of acute pancreatitis?

Answer 7

Question 8

What would you expect to find on Abdominal Xray of acute pancreatitis?

Answer 8

Question 9

What would you expect to find on CT contrast of acute pancreatitis? What is the purpose of the CT and when is it performed?

Answer 9

Question 10

Outline the components of the glasgow criteria and state the interpretation of its results.

Answer 10

for risk stratification

Question 11

What investigations will you order for acute pancreatitis?

Answer 11

+ CRP to monitor disease activity

Question 12

List the complications of acute pancreatitis.

Answer 12

Question 13

Other than the glasgow criteria, what other criterias can be used? How is it different to the glasgow criteria.

Answer 13

other - apache

Question 14

What would you expect to find on a CXR of ARDS?

Answer 14

Question 15

What would you see on CT pancreas in the setting of hypocalcemia?

Answer 15

in peripancreatic fat

Question 16

What are the systemic complications of acute pancreatitis?

Answer 16

+ mortality

Question 17

What are the local complications of acute pancreatitis? List ttek… don’t be trying to show off now. Yes you Abdul!

Answer 17

peripancreatic necrosis
pancreatic abscess
pancreatic pseudocyst
chronic pancreatitis
pancreatic haemorrhage

Question 18

How does pancreatitis cause transverse colon necrosis.

Answer 18

peripancreatic necrosis spreading to surrounding organs.

Question 19

Define peripancreatic necrosis. When should it be suspected and how is diagnosed?

Answer 19

Question 20

How would you treat peripancreatic necrosis or gangrene?

Answer 20

necrosectomy and drainage

Question 21

What is a pancreatic abscess. How does it present and what is the tx?

Answer 21

Question 22

What is a pancreatic pseudocyst? What are the possible sequelae? How is it managed?

Answer 22

Question 23

How would the glasgow criteria affect you management plan for acute pancreatitis?

Answer 23

if severe - 3+ - HDU or ICU

Question 24

Why are PPIs give in acute pancreatitis?

Answer 24

to prevent stress ulceration

Question 25

A patient with acute pancreatitis is requiring a calcium infusion. What cautions should be taken when delivering the infusion?

Answer 25

Calcium infusions, particularly intravenous calcium gluconate or calcium chloride, are often administered in a High Dependency Unit (HDU) or Intensive Care Unit (ICU) due to the potential cardiac risks associated with its administration and the need for close monitoring.

Question 26

Outline the management of acute pancreatitis and its complications.

Answer 26

Question 27

Outline the measures to prevent recurrence of acute pancreatitis.

Answer 27

Question 28

What are 2 poor prognostic factors of acute pancreatitis?

Answer 28