Acute pancreatitis

Question 1

Define acute pancreatitis

Answer 1

Acute inflammatory process of the pancreas w/ variable involvement of other regional tissue or remote organ systems

Question 2

Classification of acute pancreatitis

2

Answer 2

Mild: minimal organ dysfunction & uneventful recovery

Severe: organ failure &/or local complications such as necrosis, abscesses & pseudocysts

Question 3

Aetiology of acute pancreatitis

Answer 3

Insult results in activation of pancreatic proenzymes within pancreatic duct/acini leading to tissue damage & inflammation

Question 4

Causes of acute pancreatitis

11

Answer 4

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/HIV/Coxsackie
Autoimmune
Scorpion venom
Hypercalcaemia
ERCP
Drugs

Question 5

Epidemiology of acute pancreatitis

prevalence, age, gender causes

Answer 5

COMMON
Peak age 60 yrs
Most common cause in males is alcohol & gallstones in females

Question 6

Presenting symptoms of acute pancreatitis

5

Answer 6

Severe epigastric pain
Radiating to back
Relieved by sitting forward
Aggravated by movement
Associated w/ anorexia, N/V

Question 7

Signs of acute pancreatitis on physical examination

4 + 2 severe

Answer 7

Epigastric tenderness
Fever
Shock
Decreased bowel sounds

In severe pancreatitis:
Cullen’s sign
Grey-Turner sign

Question 8

Investigations for acute pancreatitis

5

Answer 8

Bloods
US
Erect CXR
AXR
CT

Question 9

Investigations for acute pancreatitis - bloods

8

Answer 9

VERY HIGH SERUM AMYLASE
High WCC
U&Es - to check for dehydration
High glucose
High CRP
Low calcium
LFTs - may be deranged if gallstone pancreatitis or alcohol
ABG - hypoxia or metabolic acidosis

Question 10

Investigations for acute pancreatitis - US

Answer 10

Check for evidence of gallstones in biliary tree

Question 11

Investigations for acute pancreatitis - erect CXR

2

Answer 11

May be pleural effusion

Check for bowel perforation

Question 12

Investigations for acute pancreatitis - AXR

Answer 12

Exclude other causes of acute abdomen

Question 13

Investigations for acute pancreatitis - CT

Answer 13

If diagnosis uncertain or if persisting organ failure

Question 14

Management of acute pancreatitis

5

Answer 14

Assessment
Medical
ERCP & sphincterotomy
Early detection & treatment of complications
Surgical

Question 15

Management of acute pancreatitis - assessment

2

Answer 15

Modified Glasgow score (combined w/ CRP >210 mg/L)

APACHE-II score

Question 16

Management of acute pancreatitis - medical

6

Answer 16

Fluid & electrolyte resuscitation
Urinary catheter & NG tube if vomiting
Analgesia
Blood sugar control
HDU & ITU care
Prophylactic antibiotics useful to reduce mortality

Question 17

Management of acute pancreatitis - ERCP & sphincterotomy

3

Answer 17

For gallstone pancreatitis, cholangitis, jaundice or dilated CBD
Ideally performed within 72 hours
All patients presenting w/ gallstone pancreatitis should undergo definitive management of gallstones during same admission or 2 weeks

Question 18

Management of acute pancreatitis - surgical

2

Answer 18

Necrotising pancreatitis should be managed by specialists

Necresectomy may be necessary

Question 19

Types of complications of acute pancreatitis

3

Answer 19

Local
Systemic
Long term

Question 20

Complications of acute pancreatitis - local

6

Answer 20

Pancreatic necrosis
Pseudocyst
Abscess
Ascites
Pseudo-aneurysm
Venous thrombosis

Question 21

Complications of acute pancreatitis - systemic

7

Answer 21

Multiorgan dysfunction
Sepsis
Renal failure
ARDS
DIC
Hypocalcaemia 
Diabetes

Question 22

Complications of acute pancreatitis - long term

1

Answer 22

Could result in chronic pancreatitis

Question 23

Prognosis of acute pancreatitis

2

Answer 23

20% have severe fulminating course w/ high mortality

Infected pancreatic necrosis has 70% mortality