Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Acute (reversible) inflammation of the pancreas due to its own digestive enzymes (autodigestion).

Question 2

What are the two main causes of acute pancreatitis?

Answer 2

Alcohol

Gallstones

Question 3

What is a good mnemonic for causes of acute pancreatitis?

Answer 3

GET SMASHED

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion venom
Hypercalcaemia/hyperlipidaemia
ERCP
Drugs e.g. azathioprine

Question 4

How would acute pancreatitis present?

Answer 4

Sudden onset severe pain in epigastrium
Fever, tachycardia, tachypnoea
Decreased bowel sounds

Grey Turner’s sign, Cullen’s sign

Question 5

What is Grey-Turner’s sign?

Answer 5

Bruising of the flanks

Question 6

What is Cullen’s sign?

Answer 6

Bruising around the umbilicus

Question 7

What investigations would you do in acute pancreatitis?

Answer 7

• BLOODS - raised amylase, lipase, CRP
• U+Es - hypocalaemia
• LFTs - if obstructive, suspect gallstones
• ABG - check for hypoxia or metabolic acidosis
• USS abdo - check for dilatation of the bile duct = obstruction
• ERCP - visualise stone
• CXR, AXR to rule out other causes (may see pleural effusion or loss of psoas shadow)

Question 8

Which enzyme marker is more specific to acute pancreatitis?

Answer 8

lipase

Question 9

Give two other condition where you might get a raised serum amylase.

Answer 9

• Ectopic pregnancy

- Peptic ulcer perforation

Question 10

How would you manage acute pancreatitis?

Answer 10

Analgesia, fluid resus and electrolyte balance restoration

48h NBM

Remove cause e.g. ERCP to remove stones or cholecystectomy

Possible ABx

Question 11

What are some possible complications of acute pancreatitis?

Answer 11

• High mortality – mainly due to ARDS
• Sepsis
• Haemorrhage
• DIC
• Metabolic disturbances e.g. ↓Ca, metabolic acidosis
• Pancreatic necrosis, pseudocyst

Question 12

How might you measure the severity of acute pancreatitis?

Answer 12

Glasgow criteria

APACHE II