Acute Pancreatitis

Question 1

Causes of pancreatitis

Answer 1

I GET SMASHED

• Idiopathic
• Gallstones
• Ethanol
• Trauma
• Steroids
• Mumps
• Autoimmune
• Scorpion bite
• Hyperlipidaemia, hypercalcaemia
• ERCP
• Drugs (thiazides)

Question 2

Presentation of acute pancreatitis

Answer 2

1. Severe epigastric pain radiating to the back, alleviated by sitting forward (may radiate down left or right side)
2. Nausea and vomiting
3. Peritonitis

Question 3

Normal lipase range

Lipase range that suggests pancreatitis

Answer 3

<160

3x upper limit suggests pancreatitis

Question 4

What happens to the calcium in acute pancreatitis?

Answer 4

Decrease (saponification)

Question 5

Ranson score

Answer 5

1. Glucose
2. Age
3. LDH
4. ALT
5. WCC

>3 acute pancreatitis highly likely

Question 6

Analgesic class contraindicated in acute pancreatitis

Answer 6

Opioids

Question 7

Which fluids should you give a patient with acute pancreatitis?

Answer 7

Hartmann’s (not saline)

Question 8

Indication for antibiotics in acute pancreatitis, and name of antibiotic used

Answer 8

Indication - febrile >4 days

Antibiotic - meropenem (also imipenem and piperacillin)

Question 9

Complications of acute pancreatitis (5)

Answer 9

• Pseudocyst +/- rupture causing pancreatic ascites
• Abscess
• Vascular complications (splenic artery aneurysm, ischaemic colitis due to middle colic artery damage)
• Progression to chronic pancreatitis
• ARDS