Acute pancreatitis

Question 1

Pathology

Answer 1

-Primary cause to the release/activation of pancreatic enzymes
-Pancreatic enzymes cause auto digestion
1-release of 02 free radicals or cytokines
2-oedema
3-Fat necrosis

Question 2

Symptoms of pancreatitis

Answer 2

-Severe abdominal pain which can radiate to the back
-Nausea/Vomiting
-Abdominal distension
-Signs of infection: tachycardia, pyrexia, hypoxia
Less common:
-Jaundice
-Acute renal failure
-Retroperitoneal hemmorage
-Effusions
-Paralytic ileus

Question 3

Tests

Answer 3

Blood tests: 
-amylase test/ lipase is significant - usually 3 times what they should be
-Calcium test: when severe- hypocalcemia will be present 
-LFT: high AST/ALT
-FBC: Raised WBC 
-Low albumin 
-Hyperglycemia- high glucose 
EUS: gallstones, pseudocysts 
ERCP
Use Glasgow scoring system

Question 4

Causes

Answer 4

• Alcohol
• Trauma e.g. post surgery , ERCP
• Gallstones
• Hypertrycidemia
• Miscellaneous e.g. drugs/virus

Question 5

Risk factors

Answer 5

• middle aged women

- young to middle aged men

Question 6

Resuscitation

Answer 6

fluids
analgesics
anti-emetics
o2
Nasogastric tube
Painkillers when required
Catherisation to monitor urine output- monitor kidney output 
Blood transfusion if Hb low
Ca supplement 
Insulin

Question 7

Treatment

Answer 7

For necrosis: CT fine needle aspiration, Antibiotics, necrostomy
For Gallstones: cholecystectomy

Question 8

Potential consequences

Answer 8

• Pseudocysts: cysts which are not confined by serosa
• Necrosis
• abcesses

Question 9

Definition

Answer 9

Sudden inflammation of the pancreas

Question 10

Visible signs of retroperitoneal hemmorage?

Answer 10

Severe bruising of the subcutaneous fat
Cullen’s sign: round umbellicus
Grey Turner’s: On top of flanks

Question 11

Severe vs Mild

Answer 11

Severe:

• organ failure and local problems
• glasgow scoring system of >3
• raised CRP

Question 12

Glasgow criteria for acute pancreatitis?

Answer 12

Pa02<8 Kpa
Age>55
WBC ELEVATED= Neutrophilia 
Low calcium 
Impaired renal function: high urea 
Low albumin 
Increased glucose 
Raised AST/ALT  and LDH (lactate dehydrogenase)

Question 13

How do gallstones cause acute pancreatitis?

Answer 13

Raise intra-ductal pressure- prevent flow of digestive enzymes
The smaller gallstones are more dangerous as they can travel further down

Question 14

Pseudocyst:

• what is it
• How could it be diagnosed?
• Treatment

Answer 14

A fluid collection which does not have epithelial lining

Diagnosis: Persistantly high serum amylase and pain
Treatment: endoscopic drainage if it does not disappear by itself

Question 15

What other problems can a pseudocyst cause?

Answer 15

• Jaundice
• Infection
• Haemmorage
• Rupture