acute pancreatitis

Question 1

what is acute pancreatitis?

Answer 1

-an acute inflammation process in the pancreas characterised by self- perpetuating pancreatic enzyme mediated auto digestion, oedema and fluid shifts

Question 2

what causes acute pancreatitis?

Answer 2

I GET SMASHES
I- idiopathic
G- gall stones (up to 65% cases)
E- ethanol (>8mg ETOH/day in men)
T- trauma
S- steroids
M- mumps (& other infections, coxsackle B & viral hepatitis)
A- autoimmune (IgG, related disease, polyarthritis nods)
S- scorpion bite/shock
H- hypercalcaemia, hyperparathyroidism, hyperlipademia
E- CCRP (5% cases)/emboli
D- drugs (azathioprine)

Question 3

symptoms of acute pancreatitis?

Answer 3

• epigastric pain that radiated to the back and Is very severe, intensity increases over an hour
• nausea + vomiting

Question 4

signs of acute pancreatitis?

Answer 4

• epigastric tenderness initially without guarding/ rebound tenderness
• Cullen’s sign
• Grey Turner’s sign

Question 5

what is Cullen’s sign?

Answer 5

-periumbilical bruising

Question 6

what is Grey Turner’s sign?

Answer 6

-bruising of flanks

Question 7

What scoring system is used to determine if a patient has acute pancreatitis?

Answer 7

Glasgow Prognostic Score
P= PaO2 <8kPa (60mmHg)
A= age> 55 years
N= neutrophils (WBC> 15 x 109/l)
C= calcium <2mmol/l
R= renal function (urea>16mmol/l)
E= enzymes (AST/ALT >200iu/L or LDH>600iul)
A= albumin <32g/L
S= sugar (glucose>10mmol/L)

Question 8

what score on Glasgow Prognostic Score would indicate severe pancreatitis?

Answer 8

> 3

Question 9

what should be done if severe pancreatitis is found?

Answer 9

critical care should be considered

Question 10

what investitions are taken place for acute pancreatitis?

Answer 10

• Bloods
• ABG
• AXR
• erect CXR
• USS
• Contrast enhanced CT

Question 11

what would be seen on the blood of someone with acute pancreatitis?

Answer 11

• increase amylase (>1000u/mL/around 3x normal amount), however amylase starts to fall within 24-48 hours so can be normal
• Increase serum lipase
• Increase CRP

Question 12

treatment for acute pancreatitis?

Answer 12

• nil by mouth
• IV saline/ crystalloids urinary catheter and consider venous pressure monitoring (for hypovolaemia)
• morphine/pethidine (analgesia)
• oxygen if hypoxic
• monitor via repeat CT scan
• treat complications

Question 13

systemic complications of acute pancreatitis?

Answer 13

• pulmonary failure/ARDS
• renal failure
• hypovolaemic shock
• sepsis
• hyperglycaemia
• hypocalcaemia

Question 14

local complications of acute pancreatitis?

Answer 14

• pseudocysts
• abscess
• necrosis +/- infection
• pancreatic ascites
• pleural effusion
• haemorrhage