GI - Complications Of Acute Pancreatitis And Chronic Pancreatitis

Question 1

Acute pancreatitis: outline 5 early systemic complications

Answer 1

• Resp: ARDS, pleural effusion
• Shock: hypovolaemic or septic
• Renal failure
• DIC
• Metabolic: low Ca2+, high glucose, metabolic acidosis

Question 2

Acute pancreatitis: outline late (>1wk) local complications

Answer 2

• pancreatic necrosis/infection/abscess
• bleeding: (eg splenic A) - may require embolisation
• thrombosis: splenic A/colic branches of SMA (may lead to bowel necrosis) or portal vein (portal hypertension)
• fistula formation: pancreato-cutaneous (skin breakdown)

Question 3

Acute pancreatitis: what is a pancreatic pseudocyst? Rx?

Answer 3

• collection of pancreatic fluid in lesser sac, surrounded by granulation tissue
• usually presents 4-6wks after acute attack, persistent abdo pain and epigastric mass
• Rx: either spontaneous resolution (<6cm) or percutaneous drainage under US if larger

Question 4

Chronic pancreatitis: causes

Answer 4

AGITS

• Alcohol
• Genetic (cystic fibrosis)
• immune (lymphoplasmacytic sclerosing pancreatitis)
• Triglycerides (raised)
• Structural: Obstruction by tumour or pancreas division (congenital 2 distinct pancreatic ducts)

Question 5

Chronic pancreatitis: presentation

Answer 5

• Bores through back, relieved by siting back or hot water bottle and exacerbated by fatty food or EtOH
• Steatorrhea and wt loss
• DM: polyuria and polydipsia
• Epigastric mass: pseudocyst

Question 6

Chronic pancreatitis: Ix

Answer 6

• Raised glucose (poor pancreatic function)
• Decreased faecal elastase: indicates poor exocrine function b/c not broken down in GI tract
• AXR: speckled pancreatic calcifications

Question 7

Chronic pancreatitis: Rx - diet and drugs

Answer 7

• Diet: no EtOH, low fat and high carb

- Drugs: analgesia (may need coeliac plexus block), enzyme supplements (Creon), ADEK vitamins, DM rx

Question 8

Chronic pancreatitis: Rx - Surgery (indications and procedures)

Answer 8

• Indications: unremitting pain, wt loss, duct blockage

- Procedures: distal pancreatectomy, other complicated things

Question 9

Chronic pancreatitis: complications

Answer 9

• Pseudocyst
• DM
• Pancreatic Ca
• Pancreatic swelling (biliary obstruction)
• Splenic vein thrombosis (splenomegaly)