Acute Pancreatitis

Question 1

Acute Pancreatitis Pathophysiology

Answer 1

-Acute inflammation releases exocrine enzymes which leads to autodigestion

Question 2

Acute Pancreatitis Aetiology

Answer 2

• Injury (ERCP)
• Viral (coxsackie, hepatitis)
• Metabolic
• Drugs
• Malignancy
• Ischaemia
• IBD…

Question 3

Acute Pancreatitis Presentation

Answer 3

• Note alcohol consumption and prodromal symptoms
• Severe upper abdo pain of sudden onset with vomiting
• LUQ of epigastrium penetrating to the back
• Decreases steadily over 72 hours
• Jaundice if liver or gallbladder involvement
• Bowel sounds usually present but can cause ileum
• Hypoxaemia is characteristic
• Third stage is extra-pancreatic symptoms including respiratory failure
• Do not label as mild until at least 48 hours after admission
• Most who develop severe disease present to ED with no signs of severe disease

Question 4

Acute Pancreatitis Ix

Answer 4

• Lipase
• FBC, U&Es, CRP
• Hypocalcaemia common
• AXR
• CT if equivocal results

Question 5

Acute Pancreatitis Differentials

Answer 5

• Renal failure
• Ectopic
• DKA
• Perforated ulcer (differentiate with lipase)

Question 6

Acute Pancreatitis Scoring System

Answer 6

• Glasgow prognostic score
• Ranson’s criteria
• APACHE II

Question 7

Acute Pancreatitis Management

Answer 7

• Morphine
• IV fluids (avoid further necrosis) with nil by mouth (further release of pancreatic enzymes)
• Antibiotics
• NG tube if severe vomiting
• Can feed EN if tube placed past ligament of Treitz providing no ileus
• ERCP if gallstones