Acute Pancreatitis

Question 1

AP is divided into?

Answer 1

a. Acute: GET SMASHED
G - Gallstones
E - Ethanol (alcohol)
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune disease (SLE/ Sjogren’s syndrome)
S - Scorpion venom
H - Hypercalcemia
E - ERCP
D - Drugs (Azathioprine, NSAIDs, or Diuretics)

b. Chronic: TIGAR - O
T - Toxins (chronic alcoholism)
I - Idiopathic
G - Genetic
A - Autoimmune
R - Recurrent acute pancreatitis
O - Obstruction (GS, Pancreatic head tumor)

Question 2

Diagnostic method and cause of death?

Answer 2

DM: US
*Findings: enlarged pancreatitis due to edema; GS
COD: MOF

Question 3

Causes of AP?

Answer 3

1. Alcohol (alimentary) - m/c in men & young pts.
2. Gallstones (common in women & elderly pts)
3. Steroids
4. Trauma
5. Autoimmune
6. Scorpion venom
7. Drugs (Azathioprine, NSAIDs, or Diuretics)
8. Penetrating peptic ulcer

Question 4

Physical Examination of AP

Answer 4

*Jaundice
*Anuria
*Difficulty breathing (30bpm)
*Hypotension
*Tachycardia

Question 5

3 Main causes of AP based on professor

Answer 5

1. Alcohol (Alimentary Pancreatitis)
2. GS (cholepancreatitis)
3. Trauma -> leads to rupture of small ducts & biologically active substance go from the pancreas & infiltrate the fatty pillow of pancreas & goes to the bloodstream & to other organs & cause damage to these tissues.

Question 6

Clinical Periods of AP

Answer 6

1. Period of enzymatic toxicemia - production of biologically active substances in an intensive manner
2. From 3-7 day, period of MOF
3. Period of purulent & necrotic complications (*Check level of amylase!!!)

Question 7

Severity of Pancreatitis

Answer 7

• Depends on the volume of influx & biologically active substance.
  *Mild: usually don’t have complications
  *Moderate & severe: if there is organ failure -> its severe & if not then it is mild.

Question 8

5 complications of AP

Answer 8

1. Parapancreatic infiltrate - painful mass on palpation
2. Acute fluid collection - fluid goes through the infiltrate (full of biologically active substances). It can lie near pancreas/inside pancreas. If it stays for >3 weeks it gets a capsule & becomes pseudocyst.
3. Enzymatic Peritonitis - occurs due to burn of peritoneum from fluid
4. Retroperitoneal Phlegmon - has no boundaries
5. Parapancreatic abscess - has boundaries

Question 9

What are the causes of early & late complications of AP?

Answer 9

Early complications: due to enzymatic toxemia
Late complications: due to MOF (due to sepsis)

Question 10

Treatment of AP

Answer 10

• Fasting (to stop production of biologically active substances)
• IV fluid & also IV feeding & control function of main organs
• Not necessary to operate unless there are purulent or destructive complications (Retroperitoneal phlegmon & abscess)

Question 11

Sign of Pancreatic Cancer (Cancer of Head of Pancreas - distal part)

Answer 11

KURVOSIA TRIAD/SYMTPOM

1. Mechanical Jaundice
2. Palpable enlarged GB “SHAPE OF LAMP”
3. Absence of pain at all!!!!

*SEMI-URGENT-> URGENT
Tx:
a. Drain bile from biliary tree (otherwise hepatocytes will die) due to long duration
b. EPST & stent for drainage