Pancreatic Disease

Question 1

What is the definition of acute pancreatitis?

Answer 1

• Acute inflammation
• Upper abdominal pain
• Elevation of serum amylase (>4x upper limit of normal)
• Severe cases may have multi-organ failure

Question 2

What are the causes of acute pancreatitis?

Answer 2

• Alcohol abuse
• Gallstones
• Drugs (NSAIDs, azathioprine and diuretics)
• Viruses
• Pancreatic carcinoma
• Metabolic (increased calcium,, increased triglycerides and decreased temp.)
• Idiopathic

Question 3

Describe the pathogenesis of acute pancreatitis

Answer 3

Primary insult > release of activated pancreatic enzymes > Auto-digestion (Pro-inflammatory cytokines, reactive oxygen species) > oedema, fat necrosis and haemorrhage

Question 4

Name the clinical features of acute pancreatitis

Answer 4

• Abdominal pain (may radiate to the back)
• Vomiting
• Pyrexia
• Tachycardia and hypovolaemic shock
• Oliguria and acute renal failure
• Jaundice
• Paralytic ileus
• Retroperitoneal haemorrhage
• Hypoxia
• Hypocalcaemia
• Hyperglycaemia
• Effusions (ascitic and pleural))

Question 5

Which investigations can be done for acute pancreatis

Answer 5

• Bloods: amylase, lipase, FBC, U&Es, LFTs, Ca2+, glucose, ABG, lipids and a coagulation screen
• AXR (ileus) and CXR (pleural effusion)
• Abdo USS (pancreatic oedema, gallstones and pseudocyst)
• CT scan (contrast enhanced)

Question 6

Which scoring system is used to assess the severity of acute pancreatitis?

Answer 6

Glasgow Criteria

Question 7

What are the factors used to assess the severity of acute pancreatitis?

Answer 7

• WCC > 15x10^9/l
• Blood glucose > 10mmol/l
• Blood urea > 16mmol/l
• AST > 200 iu/l
• LDH > 600 iu/l
• Serum albumin < 32g/l
• Serum calcium < 2.0 mmol/l
• Arterial PO2 < 7.5 kPa

Score > 3 (within 48hrs of admission) or CRP > 150mg/l = severe pancreatitis

Question 8

How can acute pancreatitis be (generally) treated?

Answer 8

• Analgesia (pethidine, indomethacin)
• IV fluids
• Blood transfusion (if Hb <10g/dl)
• Monitor urine output
• NG tube
• Oxygen
• May require insulin
• Nutrition (enteral or parenteral) in severe cases

Question 9

How can acute pancreatitis be (specifically) treated?

Answer 9

• Pancreatic necrosis: CT guided aspiration and antibiotics +/- surgery
• Gallstones: EUS/MRCP/ERCP and cholecystectomy

Question 10

Which treatments have no benefit in the management of acute pancreatitis?

Answer 10

• Antiproteases
• Antibiotics
• Inhibitors of pancreatic secretion (glucagon and somatostatin)
• Peritoneal lavage

Question 11

What are the potential complications of acute pancreatitis and how can they be managed?

Answer 11

-Abscess: antibiotics and drainage
-Pseudocyst (fluid collection without an epithelial lining)
-Persistent hyperamylasaemia
+/- pain
-Dx by USS or CT scan
-Can lead to jaundice,
infection, haemorrhage and
rupture
-Endoscopic drainage or
surgery if persistent pain or
complications