Acute pancreatitis

Question 1

What is acute pancreatitis

Answer 1

acute inflammation of pancreas –> rel exocrine enzymes which cause auto-digestion of organ
- may involve local tissue/ distant organ

Question 2

How common is it

Answer 2

150-420 per million population

10-15% mortality

Question 3

What causes acute pancreatitis

Answer 3

GET SMASHED

• Gallstones
• Ethanol (Alcohol)
• Trauma
• Steroids
• Mumps
• AUTOIMMUE (PAN)
• Scorpion venom
• Hyperlipidaemia
• ERCP (Endoscopic retrograde cholangiopancreatography)
• Drugs - azathioprine (immunosupressant)
• PREGNANCY

Question 4

What is the pathophysiology of acute pancreatitis

Answer 4

• Self-perpetuating
• Abnormal activation of pancreatic enzymes e.g. trypsinogen
• Converted to active forms e.g. trypsin
• Digest proteins + cause further necrosis of pancreas
• Can rapidly progress from mild oedema to necrotizing pancreatitis
• Can develop cysts + pseudo-cysts

Question 5

What are the symptoms

Answer 5

• Epigastric pain (through to back) - sudden onset
• Central abdo pain
• Sitting forward may relieve pain
• Profuse vomiting

Question 6

What are the signs

Answer 6

• Tachycardia, fever, shock
• jaundice
• rigid abdo +/- tenderness
• CULLEN’S SIGN (bruising on umbilicus)
• GREY TURNER’S SIGN (bruising on flanks)
• -> BVs in autodigestion + retroperitoneal haemorrhage

Question 7

What are the differential diagnoses

Answer 7

• Peptic ulcer disease
• Perforated viscus
• Intestinal obstruction
• AAA
• Cholangitis
• Cholecystitis
• Viral gastroenteritis
• Hepatitis

Question 8

What investigations do you do

Answer 8

Bloods 
 o	RAISED AMYLASE  
        = >1000U/mL
 o	RAISED LIPASE
       (more sensitive +specific) 
 o	If lipase:amylase ratio is 
        >3:1 = pancreatitis is due 
        to alcohol
 o	Low calcium
 o	Glycosuria 
CT, MRI and ERCP can assess extent of damage

AXR – no psoas shadow = ^ retroperitoneal fluid

Question 9

What are some complications

Answer 9

• When pancreatic cells injured they release many enzymes/proteins
• -> leaky capillaries (hypovolaemia), acute resp distress synd, pleural effusion, hypoxia, HF, GI haemorrhage

Question 10

How do you manage it

Answer 10

• NBM
• fluid resus - 0.9% saline
• Analgesia
  (morphine - can cause sphincter of Oddi to contract)
  (Perthidine)
• Prochlorperazine - nausea
• Hourly assessment
• ERCP + removal all gallstone if present