CT 2.3 Acute Pancreatitis

Question 1

what is acute pancreatitis

Answer 1

a discrete episode of acute inflammation of the pancreas resulting in abdominal pain + elevation of serum pancreatic enzymes.

may cause damage to pancreas or adjacent structures

Question 2

what are the symptoms of acute pancreatitis

Answer 2

• epigastric abdominal pain
• N+V
• fever
• tachycardia and hypotension
• mild jaundice

Question 3

what are the causes of acute pancreatitis

Answer 3

Idiopathic

gallstones
ethanol
trauma /sphincter of oddi dysfunction

Steroids
Mumps +coxsackie B virus
Autoimmune
Scorpion bites
Hypercalcemia + hypertriglyceridemia
ERCP
Drugs (immunosupressants, chemo, antimicrobials, hormone therapy, statins)

Question 4

what are the investigations for AP

Answer 4

FBC - raised WCC, LFTs, U+Es, glucose and calcium

• serum amylase (or lipase) should be raised 2/3X of normal limit
  radiology

raised ALT indicative of gallstone associated pancreatitis

Question 5

what are other differentials to keep in mind that present similarly to AP

Answer 5

• perforated peptic ulcer
• intestinal obstruction
• cholecystitis
• generalised peritonitis
• mesenteric ischemia
• ruptured AAA/ectopic

Question 6

what scoring system is used for AP

Answer 6

• Ransons
• glasgow imrie*** most commonly used
  -modified marshall

Question 7

what is the threshold for scoring a severe AP on the glasgow imrie system

Answer 7

> 3

p = p02
age >55
N - WCC
Ca
R: urea
E: LDH
Albumin
S blood sugar

Question 8

what imaging is best for diagnosing AP

Answer 8

CT

• ultrasound is good for gallstones, bile duct stones and bile duct dilatation but not specific enough for AP

in general imaging is rather more helpful for investigating the cause of pancreatitis

Question 9

what is the treatment of AP

Answer 9

acute phase: ABCD approach
treatment of the cause:
antibiotics if needed
nutritional support (oral or NG tube)

Question 10

what are the complications of AP

Answer 10

pancreatic necrosis (best diagnosed via CT scan 4-5 days later)

pancreatic abscess

haemorrhagic pancreatitis

pancreatic pseudocysts

diabetes

Question 11

what are pancreatic pseudocysts

Answer 11

appear 4-6 weeks after AP
cysts are filled with a combination of pancreatic enzymes, necrotic tissue, and inflammatory fluids.

most resolve on their own but some may require draining

Question 12

what are the signs of AP

Answer 12

cullens sign - bruising in the umbilical region (can take 24-48 hrs to appear)

grey turner’s sign - bruising for haemorrhagic pancreatitis occurring in the flank region. is a sign of retroperitoneal haemorrhage and severe AP

Question 13

what is chronic pancreatitis

Answer 13

long-standing inflammation of the pancreas that causes irreversible damage to its structure and function. Over time, this inflammation leads to scarring (fibrosis), calcification, and loss of both digestive enzyme production and insulin-producing cells.

causes:
LT alcohol abuse
autoimmune
hypertriglcyerides

Imaging tests: CT scan, MRI, or endoscopic ultrasound (EUS) to visualize structural changes.
Functional tests: Fecal elastase to assess pancreatic enzyme production.
Blood tests: For glucose and pancreatic enzyme levels.