Pancreatitis

Question 1

Pathophysiology of acute pancreatitis?

Answer 1

autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

Question 2

List 4 causes of pancreatitis

Answer 2

1. Gallstones
2. Alcohol
3. Post-ERCP
4. Trauma

Question 3

List 2 drugs associated with pancreatitis

Answer 3

1. Furosemide
2. Azathioprine
3. Thiazide
4. Mesalazine

Question 4

Pathophysiology of “Gallstone pancreatitis”

Answer 4

1. Stones get trapped at the ampulla of vater
2. Reflux of bile into the pancreatic duct and the no outflow of pancreatic juice into duodenum
3. Results in inflammation in the pancreas

Question 5

Pathophysiology of “alcoholic pancreatitis”

Answer 5

Alcohol is directly toxic to pancreatic cells, resulting in inflammation

Question 6

List 4 features of acute pancreatitis

Answer 6

1. Severe epigastric pain radiating to the back
2. Vomiting
3. Abdominal tenderness
4. Systemically unwell (eg. low-grade fever and tachycardia).

Question 7

List 2 signs on examination of pancreatic cancer

Answer 7

Cullen’s sign - Periumbilical discolouration

Grey Turner’s sign - Flank discolouration

Question 8

List 4 blood Investigations for acute pancreatitis

Answer 8

1. FBC
2. U&E
3. Serum amylase
4. Serum lipase

Question 9

List 3 imaging investigations for acute pancreatitis

Answer 9

1. USS abdomen - to look for gallstones
2. MRCP - to look for obstructive pancreatitis (ERCP is often preferred)
3. CT scan for complications (ie. pseudocysts or necrotising pancreatitis)

Question 10

What scoring system can be used to assess the severity of pancreatitis?

Answer 10

The modified Glasgow criteria:

• 0 or 1 – mild pancreatitis
• 2 – moderate pancreatitis
• 3 or more – severe pancreatitis

Question 11

Management of acute pancreatitis

Answer 11

1. ABCDE, IV fluids, Nil by mouth, Analgesia
2. Careful monitoring
3. Treatment of stones in gallstone pancreatitis
4. Antibiotics if infection (eg. abscess or infected necrotic area)
5. Treatment of complications

Question 12

Treatment for gallstone pancreatitis?

Answer 12

ERCP or cholecystectomy

Question 13

Treatment for an obstructed biliary system?

Answer 13

ERCP

Question 14

List 4 complications of acute pancreatitis

Answer 14

1. Necrosis of the pancreas
2. Infected area of necrosis
3. Abscess formation
4. Pseudocysts can develop ~ 4 weeks later
5. Chronic pancreatitis

Question 15

What is a Pseudocyst?

Answer 15

fluid-filled sac of pancreatic enzymes, blood and necrotic tissue which forms in the abdomen

Question 16

What is chronic pancreatitis?

Answer 16

Chronic inflammation and fibrosis of both the exocrine and endocrine components of the pancreas

Question 17

List 4 causes of chronic pancreatitis

Answer 17

1. Alcohol
2. Cystic fibrosis
3. Pancreatic cancer
4. Haemochromatosis

Question 18

List 3 features of chronic pancreatitis

Answer 18

1. Epigastric pain - worse after eating fatty food and relieved by sitting forward
2. Malabsorption and steatorrhoea
3. T1DM with thirst and polyuria

Question 19

Investigations for chronic pancreatitis

Answer 19

1. Abdominal x-ray - calcifications
2. CT scan - calcifications (more sensitive)
3. Faecal elastase (exocrine function)
4. Fasting glucose/OGTT test (endocrine function)

Question 20

What investigation may help differentiate acute vs chronic pancreatitis?

Answer 20

Serum amylase and lipase are not typically raised in chronic pancreatitis

Question 21

Management of chronic pancreatitis

Answer 21

1. Abstinence from alcohol and smoking
2. Analgesia
3. Pancreatic enzymes (Creon)
4. Insulin for diabetes
5. ERCP stenting for strictures and obstruction
6. Surgery for severe complications

Question 22

List 2 complications of chronic pancreatitis

Answer 22

1. Pseudocyst
2. Pancreatic cancer
3. DM
4. Malabsorption and steatorrhoea