ACUTE PANCREATITIS

Question 1

WHAT IS ACUTE PANCREATITIS?

Answer 1

• premature and exaggerated activation of digestive enzymes within the pancreas leading to auto-digestion or pancreatic tissue

Question 2

WHAT IS THE CAUSE OF ACUTE PANCREATITIS?

Answer 2

Gallstones (ampulla of Vater) 
Ethanol
Trauma
Steroids
Mumps 
Autoimmune
Scorpion bite
Hypercalcemia 
ERCP
Drugs

Question 3

WHAT ARE THE SYMPTOMS OF ACUTE PANCREATITIS?

Answer 3

1) Sudden onset of severe epigastric pain which radiates to the back - worsens with movement, and some patients find it is eased by taking the fetal position
2) Nausea
3) Vomiting

Question 4

WHAT ARE THE SIGNS OF ACUTE PANCREATITIS?

Answer 4

1) Epigastric tenderness
2) Soft abdomen
3) Ileus - no bowel sounds
4) Rare- Grey turner’s sign (flank bruising) and Cullen’s sign (bruising around umbilicus) showing retroperitoneal haemorrhage

Question 5

WHAT ARE THE DIFFERENTIAL DIAGNOSIS OF ACUTE PANCREATITIS?

Answer 5

1) AAA
2) Chronic pancreatitis
3) Aortic dissection
4) Duodenal ulcer

Question 6

WHAT ARE THE LAB INVESTIGATIONS FOR ACUTE PANCREATITIS?

Answer 6

1) Routine blood test- FBC
2) Serum amylase (diagnostic x3 high)
3) LFTS -elevated ALT
4) Serum lipase - more accurate than amylase, but not routine
5) CRP

Question 7

WHAT IMAGING INVESTIGATIONS ARE DONE FOR ACUTE PANCREATITIS?

Answer 7

1) Abdominal USS - identify gallstones or underlying cause

2) Abdominal CT - if complications suspected or diagnosis not certain

Question 8

WHAT SUPPORTIVE TREATMENT IS GIVEN FOR ACUTE PANCREATITIS?

Answer 8

1) High flow oxygen
2) IV fluid resuscitation
3) NG tube (if profuse vomiting)
4) Catheterisation (monitor urine output)
5) Opioid analgesia
6) IV antibiotic
7) Treat underlying cause - gallstones with laparoscopic cholecystectomy, alcohol cessation

Question 9

WHAT ARE THE COMPLICATIONS OF ACUTE PANCREATITIS?

Answer 9

1) Hyperglycaemia - secondary to destruction of islet of Langerhans
2) Pancreatic necrosis - ongoing inflammation leads to ischaemic infarction, this is prone to infection

Question 10

WHAT IS THE PURPOSE OF SERUM AMYLASE?

Answer 10

• diagnostic not prognostic

Question 11

WHAT SCORING SYSTEM IS USED TO DETERMINE SEVERITY OF ACUTE PANCREATITIS?

Answer 11

- Glasgow- Imrie criteria
P - Pa02< 8kPa, hypoxic
A - 55 yo
N - neutrophil high
C - hypocalcaemia
R - renal function, urea >16mmol/l 
E - enzymes
A - albumin 
S - hyperglycaemia 
If the score ≥ 3 within first 48 hours, severe pancreatitis likely- suggest refer to HDU/ICU and if the score < 3, severe pancreatitis is unlikely.