Acute_Pancreatitis_Flashcards

Question 1

Definition

Answer 1

Acute pancreatitis refers to an inflammatory process affecting the pancreas as well as local or distant tissues and organs in some cases.

Question 2

Epidemiology

Answer 2

Incidence: 30 cases per 100,000 people/year. Half caused by gallstones, a quarter by alcohol, 10% idiopathic. 80% are mild/self-limiting (1-3% mortality); 20% moderate/severe cases have higher mortality (13-35%).

Question 3

Aetiology

Answer 3

Mnemonic GET SMASHED: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune diseases, Scorpion stings, Hypercalcaemia/hypertriglyceridemia, ERCP, Drugs. Other causes include trauma, microlithiasis, tumors, congenital abnormalities.

Question 4

Classification

Answer 4

Glasgow Score for severity: PaO2 < 8kPa, Age > 55, Neutrophils > 15, Calcium < 2, Urea > 16, LDH > 600/AST > 200, Albumin < 32, Glucose > 10. Score of 3+ predicts severe pancreatitis.

Question 5

Signs and Symptoms

Answer 5

Main symptom: epigastric pain radiating to the back. Other symptoms: nausea, vomiting, diarrhea. Signs: abdominal tenderness, distension, fever, tachycardia, Grey-Turner’s sign, Cullen’s sign, Fox’s sign.

Question 6

Differential Diagnosis

Answer 6

Differential: Acute coronary syndrome, perforated peptic ulcer, ruptured abdominal aortic aneurysm, bowel obstruction, cholecystitis.

Question 7

Investigations

Answer 7

Tests: ABG, ECG, glucose, FBC, CRP, U&Es, LFTs, amylase, lipase, LDH, calcium, blood cultures, imaging (US, CXR, CT pancreas, MRCP).

Question 8

Management

Answer 8

Conservative: NG tube, oral/enteral nutrition. Medical: IV fluids, analgesia, antiemetics, antibiotics if needed. Surgical: ERCP for gallstones, cholecystectomy, interventions for complications.

Question 9

Complications

Answer 9

Local: pseudocysts, necrosis, abscesses, hemorrhage, fistulae. Systemic: ARDS, AKI, DIC, sepsis, multi-organ failure, hypocalcaemia, hyperglycaemia.

Question 10

Summary

Answer 10

Acute pancreatitis refers to inflammation of the pancreas; there are a wide variety of causes and severity ranges from mild and self-resolving pancreatitis to life-threatening multi-organ failure. The main symptom is acute-onset epigastric pain which radiates to the back, which may be accompanied by nausea and vomiting. Diagnosis is primarily with bloods showing an elevated amylase or lipase. Abdominal ultrasound is another important investigation to look for gallstones (the commonest cause of acute pancreatitis). General management includes aggressive fluid resuscitation, analgesia, antiemetics and nutritional support.