Acute Pancreatitis

Question 1

What is the pneumonic for causes of pancreatitis?

Answer 1

GET SMASHED

Gallstones
Ethanol
Idiopathic
Trauma
Steroids
Mumps (+ others - coxsackie B)
Autoimmune: eg PAN
Scorpion stings
Hyperlipidaemia, hypercalcaemia, hypothermia
ERCP
Drugs: eg thiazides, azothioprine

Question 2

What is the most common cause of pancreatitis?

Answer 2

Gallstones (45%)

Alcohol 25%, Idiopathic 20%

Question 3

How would a sufferer of pancreatitis describe the pain?

Answer 3

Sudden onset severe epigastric pain, radiating to back, relieved by sitting forward

Question 4

What are the two main features of pancreatitis?

Answer 4

Pain (specific description, see earlier)

Vomiting

Question 5

Pancreatitis leads to leakage of pancreatic enzymes causing 6 main presenting features

Answer 5

High HR
High RR
Hypovolaemia (shock)
Epigastric tenderness
Ecchymosis (bruising)
Jaundice
Ileus

Question 6

What are the special types of bruising found in acute pancreatitis?

Answer 6

Grey-Turner’s: flank bruising

Cullen’s: periumbilical bruising - tracking up falciform

Question 7

What are the three main differentials of pancreatitis?

Answer 7

Perforated DU
Mesenteric infarction
MI

Question 8

What criteria is used to assess severity and predict mortality in acute pancreatitis caused by alcohol and gallstones?

Answer 8

Modified Glasgow criteria
1=mild, 2=mod, 3=severe (detected within 48hrs)

PANCREAS
Pa02 55yrs
Neutrophils >15x10 to the 9/L
Ca++ 16mM
Enzymes LDH>600iu/L, AST>200iu/L
Albumin 10m

Question 9

Can amylase be normal in acute pancreatitis?

Answer 9

Yes

Question 10

What is the more sensitive enzyme to measure for pancreatitis?

Answer 10

Serum lipase

Question 11

First conservative steps in acute pancreatitis? (4)

Answer 11

NBM
Fluid resus
Insert catheter + assess urine output
TPN?

Question 12

Two main medications used in acute pancreatitis?

Answer 12

Analgesia: pethidine/morphine

ABx only if suspicious of infection: meropenem/imipenem

Question 13

What are the four main management complications to consider in a patient with acute pancreatitis?

Answer 13

ARDS
Hyperglycaemia
Hypo/hypercalcaemia
EtOH withdrawal: chlordiazepoxide

Question 14

What imaging would you use to assess acute pancreatitis?

Answer 14

CXR: looking for ARDS, exclude perf
AXR: sentinel loop, pancreatic calcification
US: gallstones, dilated ducts, inflammation
Contrast CT

Question 15

If dilated ducts found on pancreatic US secondary to gallstones - what is the next plan of action?

Answer 15

ERCP + sphincterotomy

Question 16

What are the indications for surgery following acute pancreatitis? (3)

Answer 16

Infected pancreatic necrosis
Pseudocyst or abscess
Unsure Dx

Question 17

What are the 5 early complications of acute pancreatitis?

Answer 17

Respiratory: ARDS, pleural effusion
Shock: hypovoleamic or septic
Renal failure
DIC
Metabolic: hypocalcaemia, hyperglycaemia, metabolic acidosis

Question 18

What are the 6 late (>1week) complications of acute pancreatitis?

Answer 18

Pancreatic necrosis
Pancreatic infection
Pancreatic abscess
Bleeding
Thrombosis
Fistula formation: pancreato-cutaneous

Question 19

In how many sufferers of acute pancreatitis does a pancreatic pseudocyst occur in?

Answer 19

20%

esp. EtOH pancreatitis