Acute Pancreatitis

Question 1

Causes of acute pancreatitis

Answer 1

Alcohol

Gallstones

Question 2

Clinical features of acute pancreatitis

Answer 2

ACUTE ABDOMEN:Sudden and severe continuous pain
Initially poorly localised: central-upper abdomen that radiates to back
Pain the spreads throughout abdomen
If diaphragmatic peritoneum becomes inflamed - pain in shoulder tips

Unrelenting vomiting
Restless - pain relieved by sitting forward
Movement becomes increasingly painful

Question 3

Investigations in acute pancreatitis

Answer 3

Plasma amylase: >1000iu/ml (but can be low in alcoholics)
Raised ALT - specific for gallstones
Erect CXR - gas under diaphragm
USS of biliary tree - small calculi in gall bladder/bile duct
ERCP - where cause not evident

Question 4

Presentation of mild acute pancreatitis

Answer 4

Pt looks well - mild  systemic features
Considerable pain
Distended abdomen, diffusely tender
Absent bowel sounds (due to inflamed ileus)
Rectal exam normal
Maybe mildly jaundiced

Question 5

Presentation of Severe Acute Pancreatitis

Answer 5

Pt looks apathetic, grey, shocked
Abdo signs - generalised peritonitis: extreme tenderness, guarding, rigidity
Acute respiratory distress syndrome - dangerous complication

Question 6

Management of mild acute pancreatitis

Answer 6

Fluid Resus
Analgesia
Treat predisposing factors - gallstones/alcoholism

Recovery usually rapid

Question 7

Management of severe attack of acute pancreatitis

Answer 7

Pts may die early due to profound systemic toxaemia and multiple organ dysfunction syndrome

Mainstay treatment - supportive measures
O2 therapy
IV fluid resus
NG tube to aspirate stomach if troublesome  vomiting
Prophylactic parenteral antibiotics