Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Self-perpetuating pancreatic enzyme-mediated autodigestion

Question 2

What is the pneumonic for the causes of AP?

Answer 2

I GET SMASHED

Question 3

What does I GET SMASHED stand for?

Answer 3

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia
ERCP/embolism
Drugs - NSAIDs, corticosteroids, ACEis

Question 4

How does AP present?

Answer 4

Severe epigastric pain that radiates to the back, anorexia, fever, jaundice, Grey Turner’s sign, N&V, tachycardia

Question 5

What serum enzymes will be elevated?

Answer 5

Amylase and lipase

Question 6

Which is more sensitive and specific for pancreatitis, amylase or lipase, and why?

Answer 6

Serum lipase as levels rise earlier and fall later

Question 7

What would expect on urinalysis?

Answer 7

Raised amylase

Question 8

What would you expect when you do a CRP?

Answer 8

Raised

Question 9

What imaging could you do?

Answer 9

CXR, abdominal USS, CT, MRI

Question 10

What are the differential diagnoses?

Answer 10

Any acute abdomen, MI

Question 11

What criteria can you use to assess severity?

Answer 11

APACHE 2, Glasgow, Ranson

Question 12

Do you give anything by mouth?

Answer 12

No

Question 13

How would you manage AP?

Answer 13

Analgesia, prophylactic antibiotics, treat gallstones if the cause

Question 14

What are some early complications?

Answer 14

Shock, ARDS, renal failure, DIC, sepsis

Question 15

What are some late (>1 week) complications?

Answer 15

Pancreatic necrosis, pseudocyst, abscesses, bleeding, thrombosis, fistulae

Question 16

What causes of AP does the modified Glasgow criteria work for?

Answer 16

Gallstones and alcohol

Question 17

What is the pneumonic for the modified Glasgow criteria?

Answer 17

PANCREAS

Question 18

What does PANCREAS stand for?

Answer 18

PaO2 - low
Age >55
Neutrophilia - WBC high
Calcium - low
Renal function - urea high
Enzymes - LDH/AST high
Sugar - blood glucose high