Acute Pancreatitis

Question 1

Description: What is acute pancreatitis?

Answer 1

• Acute inflammation of the pancreas

Question 2

Aetiology/Risk Factors: What are the causes of acute pancreatitis?

Answer 2

I GET SMASHED

• Idiopathic (10%)
• Gallstones
• Ethanol (alcohol)
• Trauma
• Steroids
• Mumps virus
• Autoimmune
• Scorpion bites
• Hypercalcemia, Hypertriglyceridaemia
• ERCP
• Drugs (e.g azarhioprine, diuretics)

Question 3

Pathology: Describe the pathology of acute pancreatitis and what this leads to.

Answer 3

• Autodigestion of the pancreas by premature activation of trypsin
• This leads to fat necrosis, oedema and haemorrhage

Question 4

Symptoms: What are the symptoms of acute pancreatitis? (2)

Answer 4

• Upper abdominal pain

- Vomiting

Question 5

Signs: What are the signs of acute pancreatitis? (9)

Answer 5

• Jaundice
• Pyrexia
• Tachycardia
• Hypovolaemic shock
• Retroperitoneal haemorrhage (Grey Turner’s and Cullen’s signs due to autodigestion of vessels)
• Paralytic ileus
• Hypoxia
• Hypocalcaemia
• Hyperglycaemia

Question 6

Investigations: State the investigations done for acute pancreatitis:

(a) Blood tests (6)
(b) Imaging Investigations (5)

Answer 6

(a) Blood tests:
- Amylase and Lipase (raised)
- FBC
- U + E
- LFTs
- White cell count
- Calcium

(b) Imaging investigations:
- Abdominal x-ray (look for paralytic ileus)
- Chest x-ray (look for pleural effusion)
- Abdominal ultrasound
- CT (contrast enhanced)
- ERCP

Question 7

Treatment: How do we assess severity of disease in acute pancreatitis?

Answer 7

Assessment of severity:

• PO2
• Age > 55 tears
• Neutrophilia (white cell count)
• Calcium
• Renal function (blood urea)
• Enzymes (AST and LDH)
• Albumin
• Sugar (blood sugar)

GLASGOW CRITERIA
SCORE >3 =
SEVERE PANCREATITIS
within 48 hrs of admission

Question 8

Treatment: Describe the general management of a patient with acute pancreatitis.

Answer 8

• Analgesia (pethidine)
• IV fluids
• Blood transfusion (Hb < 10 g/dL)
• Nasogastric tube
• Oxygen (RESP)
• Calcium supplements
• Monitor urine output (RENAL)

Question 9

Treatment: Describe the specific management of a patient with acute pancreatitis.

Answer 9

Specific management:

• If there is pancreatic necrosis then do a CT guided aspiration
• If there is gallstones then do a endoscopic ultrasound/ERCP AND cholecystectomy
• Treat the cause (e.g counselling for alcohol, resection for malignancy), statins for hyperlipidaemia)
• Manage complications (antibiotics)
• Repeat CT scans (look out for complications)

Question 10

Treatment: Describe the definitive management of a patient with acute pancreatitis.

Answer 10

Definitive management:

• Prevent recurrent attacks (i.e manage gallstones and alcohol)
• Collect any fluid
• Manage necrosis (laparotomy and necrosectomy)
• Manage complications

Question 11

Complications: What are the local complications of acute pancreatitis? (4)

Answer 11

Local complications of acute pancreatitis:

• Pancreatic necrosis
• Pancreatic abscess (give antibiotics + drainage)
• Pseudocyst
• Acute fluid collection

Question 12

Complications: What are the complications of a pseudocyst? (4)

Answer 12

Complications of pseudocyst:

• Jaundice
• Infection
• Rupture
• Haemorrhage