acute pancreatitis

Question 1

describe the pathology

Answer 1

pancreatic enzymes are released and activated, and they auto digest the pancreas

Question 2

stage 1

Answer 2

oedema and fluid shift cause hypovolaemic shock, and fluid and enzymes in the peritneoa cavity autodigest the fat affecting Ca binding causing hypocalcaemia

Question 3

stage 2

Answer 3

autodigestion of blood vessels causes retroperitoneal haemorrhage

Question 4

stage 3

Answer 4

infarction due to comprmised blood supply causes pancreatic necrosis

necrotic tissue becomes infacted causing abscess formation

Question 5

clinical features PAN

Answer 5

diffuse pain radiating to back - relieved by sitting up

anorexia nausea and vomiting

and erythema abigne

Question 6

how can severe acute pancreatitis present

Answer 6

like peritonitis with widespread guarding and absent BS

Question 7

flank brusing

Answer 7

grey turner’s sign

Question 8

periumbilical bruising

Answer 8

cullen’s sign

Question 9

cardiac like symptoms

Answer 9

hypotension and tachycardia

Question 10

reason for hypotension and tachycardia

Answer 10

in hypovolaemic shock due to cerebral oedema and fluid shift

Question 11

general symtoms

Answer 11

abdominal pain loss of appetite - weight loss temperature jaundice

Question 12

causes

Answer 12

Gallstone Ethanol Trauma Scorpion or spider Mumps Autoimmune Steroid Hyper lipidaemia/calcaemia ERCP Drugs

Question 13

diagnosis - amylase lipase

Answer 13

increased

Question 14

what imaging must you do on 24hr admission

Answer 14

US assessment of biliary tree

Question 15

standrad imaging for assessing severity and complications

Answer 15

CT MRI better

Question 16

what would you see on CXR

Answer 16

sentinel loop pleural effusion

Question 17

complications

Answer 17

ARDS renal or organ failure

shoch

hyperglycaemia

Question 18

how do pseudocysts form

Answer 18

fibrous tissue surrounds liquefactive necrosis

Question 19

pseudocysts can lead to what

Answer 19

abscess (present with the hallmarks of infection)

Question 20

treatment

Answer 20

analgesia and fluids IV

NJ feeding

ERCP if gallstones

drain abscess/pseudocyst

Question 21

P

Answer 21

PaO2 <8

Question 22

A

Answer 22

age >55

Question 23

N

Answer 23

WBC >15

Question 24

C

Answer 24

calcium <2

Question 25

R

Answer 25

urea >16

Question 26

E

Answer 26

LDH >600 AST >200

Question 27

A

Answer 27

<32

Question 28

S

Answer 28

blood glucose >10

Question 29

give 2 examples of proteases and what they do

Answer 29

trypsin and chymotrypsin

polypeptides to peptides

Question 30

what does pancreatic lipase to

Answer 30

triglycierides into fatty acids and monoglycerides

Question 31

pancreatic amylase

Answer 31

carbohydrates into disacchardies and monosaccharides

Question 32

what do the epithelial cells secrete

Answer 32

water and bicarbonate

Question 33

what are pancreatic fluid secretions regulated by

Answer 33

CNX and gastrin levels