Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

• Inflammation of the pancreas

* Pancreatic enzymes (amylase / lipase) attack the pancreatic tissue

Question 2

What type of pain is classical in pancreatitis?

Answer 2

•Cause epigastric pain radiating to the back

Question 3

How is pancreatitis diagnosed?

Answer 3

• Diagnosed clinically / by rise in amylase (>3 x normal) / CT scan
• Amylase may not rise in and acute exacerbation of chronic pancreatitis because the pancreas has lost it’s ability to produce the enzyme

Question 4

What is the Glasgow Score?

Answer 4

P – Pa02 < 60
•A – Age > 55
•N – Neutrophils (WBC > 15)
•C – Calcium < 2
•R – uRea >16
•E – Enzymes (LDH > 600 or AST/ALT >200)
•A – Albumin < 32
•S – Sugar (Glucose >10)

• <2: mild
• 2: moderate
• > 2: severe
• Consider intensive care intervention/review when score is >1

Question 5

What are the causes of pancreatitis?

Answer 5

Gallstones
Ethanol 
Trauma 
Steroids 
Mumps
Autoimmune
Scorpion
Hypertriglycerides
ERCP 
Drugs

Question 6

What are complications of pancreatitis?

Answer 6

• Pancreatitic necrosis
• Infection in necrotic areas
• Pseudocysts
• Chronic pancreatitis

Question 7

Managing pancreatitis?

Answer 7

• Patients can become extremely sick very quickly
• Escalate care according to Glascow score
• Careful monitoring
• IV fluids
• Analgesia
• Endoscopic drainage of large pseudocysts
• Antibiotics only if evidence of infected pancreatic necrosis
• Surgery to remove infected pancreatic necrosis