Appendicitis and Pain

Question 1

What is acute pancreatitis?

Answer 1

acute inflammatory process that leads to necrosis of the pancreatic parenchyma

Question 2

What are signs and symptoms of acute pancreatitis?

Answer 2

severe abdominal pain
nausea
vomiting
diarrhoea
fever
shock (high pulse, low BP)
delayed capillary refill due to shock (>2s)

Question 3

What is the diagnostic approach?

Answer 3

history
examination
tests
(simple, blood tests, complex blood test, simple imaging, cross sectional imaging, invasive test)

Invasive test - ERCP
Imaging - chest Xray, abdo X ray, US, CT and MRCP

Question 4

Typical blood tests for acute pancreatitis?

Answer 4

WCC
CRP
Amylase
Bil, ALT, ALP

Question 5

What are the scoring systems used for AP?

Answer 5

Ranson’s criteria (alcoholic pancreatitis)
APACHE II
SIRS
signs of being very unwell

Question 6

What are the SIRS criteria?

Answer 6

temperature
HR > 90
respiratory rate >20, PaCO2 <32
WBC count >12000 cells, <4000

Question 7

What are the risk factors for severity of AP?

Answer 7

necrosis vs non necrosis
organ failure
age
co morbidities
alcohol

Question 8

What are the causes of acute pancreatitis?

Answer 8

Gallstones (most common)
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia/ Hypercalcaemia/Hypothermia
ERCP
Drugs (azathioprine, valproate)

Question 9

What are systemic complications of AP?

Answer 9

Hypovolaemia
Hypoxia
Hypocalcaemia
Hyperglycaemia
DIC (uncontrolled bleeding and haemorrhage)
Multiple organ failure

Question 10

What are localised complications of AP?

Answer 10

Pancreatic necrosis
Fluid collections – mature into pseduocysts
Splenic vein thrombosis/pseudoaneurysm
Chronic Pancreatitis

Question 11

What are supportive treatments for AP?

Answer 11

Fluids
Painkillers
Nutrition
Organ Support
Management of complications

Question 12

What is chronic inflammation?

Answer 12

progressive fibro-inflammatory process of the pancreas that results in permanent structural damage, which leads to impairment of exocrine and endocrine function

Question 13

What are signs and symptoms of CP?

Answer 13

malabsorption
loss of exocrine function
fat soluble vitamin malabsorption (ADEK)
- steatorrhea

Question 14

How is CP investigated?

Answer 14

plain X ray - outline pancreas, microcalcification
CT
faecal elastase - marker of pancreatic exocrine insufficiency

Question 15

Management for CP?

Answer 15

Stop alcohol and smoking
Small meals with low fat
PPI and pancreatic supplements
Analgesia