Pancreatitis

Question 1

What are the causes of pancreatitis (mnemonic)

Answer 1

Idiopathic

Gallstones (v common)
Ethanol (most common)
Trauma

Scorpion venom
Mumps/malignancy
Autoimmune
Steroids
Hypertriglycerides, hypercalcemia
ERCP
Drugs

Question 2

What common drugs are known to cause pancreatitis

Answer 2

thiazides, furosemide
azathiopurine
tetracyclines, sulphonamides
sodium valproate
oestrogens
corticosteroids

Question 3

What are the

• symptoms
• signs
• investigations of acute pancreatitis

Answer 3

Sudden-onset abdominal pain with back radiation

• nausea and vomiting are often present
• history of gallstones, excessive alcohol intake
• decreased appetite due to pain
• jaundice if gallstone related

Signs

• epigastric tenderness
• fever and tachycardia.
• hypovolemia

Investigations

• raised blood lipase or amylase levels
• abdominal CT may confirm pancreatic inflammation.
• U&E

Question 4

What are the possible differentials for acute pancreatitis

Answer 4

GI

• peptic ulcers => epigastric, no back radiation, reflux, anorexia
• obstruction => surgical history, distension, anorexia, vomiting
• cholangitis => Charcot’s triad (jaundice, RUQ, fever
• choledocholithiasis => RUQ, jaundice
• cholecystitis => pain after fatty meal in RUQ, anorexia, N+V, fever
• hepatitis => jaundice, RUQ, anorexia, tired

CV

• AAA => CV risk factors, tearing abdo pain, hypotension, mottled lower extremities, abdo distension
• MI

Question 5

How would you manage acute pancreatitis

Answer 5

Fluid resus - IV Hartmann’s, monitor fluid output with catheter

If in pain, follow WHO pain ladder,
If vomiting, use ondansetron
If hypoxemic, give O2
If high suspicion of infection
-for extrapancreatic infection => empirical
-for pancreatic infection
=> carbapenem FIRST LINE or metronidazole

Nutrition => low fat oral intake if possible
-may consider enteral feeding if unable to feed orally

Question 6

What are the complications of pancreatitis

Answer 6

Pancreatic

• abscess => fluid collections are infected, need to be drained
• pancreatic ascities => fluid filled with amylase

Extrapancreatic

• acute renal failure => due to hypovolemia
• sepsis
• ARDS => inflammatory mediators damage lung