Pancreas

Question 1

What are the causes of Pancreatitis?

Answer 1

I GET SMASHED

I- idiopathic 
G- Gall stones 
E- Ethanol 
T- Trauma 
S- Steroids 
M- Mumps 
A- Autoimmue 
S- Scorpion stings/Spider bites 
H- Hyperlipaemia/HyperCalcaemia/Hyperparathyroidism 
E- ERCP 
D- Drugs (tetracycline, furosemide, azathioprine, thiazides and many others)

Question 2

What are the 3 criteria for diagnoses pancreatitis?

Answer 2

• Acute onset persistent Severe epigastric pain (radiates to back)
• Amylase or Lipase >3 times the upper limit of normal (0-160)
• characteristic imaging on CT contract, MRI or USS

Question 3

How does pancreatitis come about?

Answer 3

• activation of intrapancreatic enzymes: blockage (gallstones) or pancreas cell insult (alcohol or drugs)
• auto-digestion of pancreatic parenchyma
• acts inflammatory cells (neurtophils + macrophages)
• Releases cytokines & causes an inflammatory response

Question 4

How does third space fluid loss happen in pancreatitis?

Answer 4

• release of inflammatory cytokines + vascular injury because of enzyme release
• leads to increased vascular permeability
• fluid leaks from vessels to third space (retroperitoneal)

Question 5

What is the PANCREAS scoring system?

Answer 5

Measures the severity of Acute pancreatitis
P- Pa O2
A -Age >55
N - neutrophils
C - Calcium 
R - Renal - Urea>16
E - ensymes - LDH
A - albumin 
S - sugar glucose >10

Question 6

What is the management of Acute pancreatitis?

Answer 6

• Pain control - opiates
• IV fluid - monitor urine output with catheter
• Severe:
• insulin
• Ca2+ correction
• Abx
• Nutrition
• observe for complications
• Manage Alcohol withdrawal

Question 7

Management of chronic pancreatitis?

Answer 7

• treat causes
• IgG4 - good steroid response
• stop alcohol or smoking
• replace exocrine function PERT 50,000 with meals
• dietician input