Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Acute pancreatitis refers to acute inflammation of the pancreas.

Question 2

What is the prevalence of acute pancreatitis in the United Kingdom?

Answer 2

Approximately 56 cases per 100,000 annually.

Question 3

What is the mortality rate for severe acute pancreatitis?

Answer 3

Severe acute pancreatitis has a high mortality rate of approximately 15%.

Question 4

What are the two types of acute pancreatitis?

Answer 4

Interstitial oedematous pancreatitis (most common, better prognosis) and necrotising pancreatitis (5-10%, more severe).

Question 5

What are the most common causes of acute pancreatitis in the UK?

Answer 5

Gallstones and alcohol.

Question 6

What mnemonic can help remember the causes of acute pancreatitis?

Answer 6

“I GET SMASHED”: Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps/malignancy, Autoimmune disease, Scorpion sting, Hypertriglyceridemia/Hypercalcaemia, ERCP, Drugs (azathioprine, thiazides, septrin, tetracyclines).

Question 7

What are the risk factors for acute pancreatitis?

Answer 7

Male gender, increasing age, obesity, and smoking.

Question 8

What are the typical symptoms of acute pancreatitis?

Answer 8

Severe epigastric pain radiating to the back, nausea, vomiting, and decreased appetite.

Question 9

What past medical history is relevant in assessing acute pancreatitis?

Answer 9

History of gallstones, biliary disease, or previous pancreatitis.

Question 10

How can recent surgical procedures relate to acute pancreatitis?

Answer 10

Recent procedures, such as ERCP, can be associated with the development of acute pancreatitis.

Question 11

What social history factors are important in acute pancreatitis?

Answer 11

Alcohol intake and smoking habits.

Question 12

What family history is pertinent to acute pancreatitis?

Answer 12

Family history of hereditary pancreatitis.

Question 13

What are common clinical examination findings in acute pancreatitis?

Answer 13

Epigastric tenderness, abdominal distension, and reduced bowel sounds.

Question 14

What systemic signs might be present in acute pancreatitis?

Answer 14

Fever, hypotension, and tachycardia, indicating a systemic inflammatory response.

Question 15

What is Cullen’s sign?

Answer 15

Periumbilical bruising associated with acute pancreatitis.

Question 16

What is Grey-Turner’s sign?

Answer 16

Flank bruising associated with acute pancreatitis.

Question 17

What initial investigations are important in suspected acute pancreatitis?

Answer 17

Serum amylase and lipase levels, liver function tests, and abdominal ultrasound.

Question 18

What imaging modality is preferred to detect gallstones in acute pancreatitis?

Answer 18

Abdominal ultrasound.

Question 19

What scoring system is used to assess the severity of acute pancreatitis?

Answer 19

The Glasgow-Imrie criteria.

Question 20

What are the components of the Glasgow-Imrie criteria?

Answer 20

Age >55 years, WBC >15x10^9/L, glucose >10 mmol/L, urea >16 mmol/L, AST >200 IU/L, LDH >600 IU/L, calcium <2 mmol/L, albumin <32 g/L, and PaO2 <8 kPa.

Question 21

What is the initial management for acute pancreatitis?

Answer 21

Supportive care with intravenous fluids, analgesia, and monitoring for complications.

Question 22

When are antibiotics indicated in acute pancreatitis?

Answer 22

Antibiotics are not routinely indicated unless there is evidence of infected pancreatic necrosis or other infections.

Question 23

What lifestyle modifications are recommended after an episode of acute pancreatitis?

Answer 23

Abstinence from alcohol and smoking cessation.

Question 24

What surgical intervention might be necessary in gallstone-induced acute pancreatitis?

Answer 24

Cholecystectomy may be required to prevent recurrence.

Question 25

What are potential complications of acute pancreatitis?

Answer 25

Pancreatic necrosis, pseudocyst formation, abscess, and systemic complications like organ failure.