Pancreas

Question 1

Describe the pathophysiology of acute pancreatitis:

Answer 1

1. Local inflammation: activation of enzymes and autodigestion
2. necrosis of pancreatic ducts and vascular structures:
3. MOSD

Question 2

List 5 local and 5 systemic complications of acute pancreatitis

Answer 2

Local:
1. pancreatic pseudocyts
2. necrosis
3abscess
4hemorrhage
5third spacing
6fistula 
7local fluid

Systemic
1/ SIRS
2. DIC
3/ ARDS
4. ARF
5. Hyperglycemia
6. Shock

Question 3

Provide 10 causes of acute pancreatitis:

Answer 3

Vascular:
- Vasculitis
- Ischemia (hypoperfusion, embolic, thrombosis)
- PAN
- HTN emergency
	
Inflammatory / Autoimmune:
- Crohn’s
- Autoimmune
- Cystic Fibrosis
- Hemochromatosis
- SLE

Metabolic:
- Uremia
- DM, DKA
- Hypercalcemia
- Hyperlipidemia

Trauma:
- Traumatic
- Hypothermia
- Perforated ulcer
- Iatrogenic (Post ERCP)
- Scorpion bite (Trinidad)
- Post-operative
- Biliary

Tumors:
- Pancreatic tumors
- Ampullary tumors

Idiopathic

Infectious
- See below

Toxic / Drugs:
- See below

Question 4

What are infectious causes of pancreatitis?

Answer 4

- Viral infections: 
	o MUMPS and coxsackie are MCC
	o Other: VZV, CMV, EBV, hepatitis ABC, measles, rubella, HIV
- Bacterial:
	o Atypicals (mycoplasma, legionella)
	o Dysentery (campylobacter, salmonella)
	o TB, toxo
	o Staph / strep (scarlet fever)
- Fungal:
	o Aspergillus, cryptococcus
- Parasite:
	o Ascariasis, clonorchiasis, toxoplasma

Question 5

List 10 definitive drug causes of pancreatitis:

Answer 5

Alcohols:
- Ethyl alcohol
	

Analgesics / OTC:
- APAP
- Ranitidine
- Cimetidine
- Salicylates
- Opiates (possible)

Antineoplastics / Immunosupressants:
- Cisplatin
- Corticosteroids
- Cyclosporine (possible)
- Azathioprine (Imuran) used in IBD

Antibiotics:
- Erythromycin
- Septra
- Tetracyclines
- Flagyl
- Nitrofurantoin
- Pentamadine
- INH (possible)

Anticonvulsants:
- VPA
- Carbamazepine (possible)

Steroids:
- Estrogens

Cardiovascular:
- Furosemide
- Clonidine (possible)
- Enalapril (possible)
- Procainamide (possible)

Psychiatric:
- Methyldopa

Miscelaneous:
- Octreotide
- Organophosphates

Question 6

List 5 DDx for elevated lipase other than pacreatitis

Answer 6

1. DKA
2. BO
3. Idiopathic
4. Renal failure
5. Drugs
6. cholecystitis
7. celiac
8. HIV
9. pacreatic stones and tumors

Question 7

What scoring systems can predict mortality in acute pancreatitis and what are severe scores

Answer 7

Ranson’s GT3 and APACHE II GT 8