Acute Pancreatitis

Question 1

Causes of acute pancreatitis

I GET SMASHED

Answer 1

Idiopathic/ iatrogenic

Gall stones
Ethanol - alcohol
Trauma

Scorpion bite 
Mumps
Autoimmune destruction 
Steroids 
Hpercalcaemia 
ERCP
Drugs - azathioprine, diuretics, valproate

Question 2

Pathophysiology

Answer 2

Acute inflammation of the pancreas due to auto digestion by pancreatic enzymes which leads to necrosis

Question 3

Symptoms

Answer 3

Severe epigastric pain
May radiate to back
Anorexia
N + V

Question 4

Signs

Answer 4

Epigastric tenderness
Low grade fever
Signs of shock - tachycardia, tachypnoea, Low BP

Cullens sign - bruising around umbilicus
Grey Turners sign - bruising on flanks

Question 5

Investigations

Answer 5

Abdominal examination 
Obs 
Bloods - FBC, U+Es, LFTs, CRP, serum amylase 3x (or lipase) 
Ultrasound 
MRCP - if gall stones confirmed 
CT - complications e.g. fluid

Question 6

Modified Glasgow criteria

Answer 6

Severity score
More than 3 - severe

PANCREAS

• PaO2
• age over 55
• neutrophils
• Calcium
• Renal function
• enzymes
• albumin
• sugar

Question 7

Treatment if no gallstones

Answer 7

Supportive: 
- oxygen 
- IV fluids 
- analgesia - tramadol 
- antiemetic - metoclopramide 
- anticoagulation - LMWH prophylaxis 
Nutritional support - not NBM 

If still symptomatic - radiological drainage

Question 8

Treatment if gallstones present

Answer 8

ERCP with stent left in for 6 weeks

Early cholecystectomy

Question 9

Complications

Answer 9

Peripancreatic fluid collection - self resolving 
Pleural effusion 
Psuedocysts 
Pancreatic necrosis 
Pancreatic abscess 
Haemorrhage 
ARDS

Question 10

Difference between chronic and Acute pancreatitis

Answer 10

Acute occurs in normal pancreas and returns to normal after resolution

Chronic - continuing inflammation with irreversible changes