pancreatitis

Question 1

2 functions of pancreas

Answer 1

Endocrine (insulin and glucagon)

Exocrine (lipase and proteases)

Question 2

how does the pancreas protect itself

Answer 2

Stores the enzymes as proenzymes (zymogens) which need to be activated. They are also packed in zymogen granules and packed with protease inhibitors if zymogens become prematurely active.

Question 3

What are zymogens activated by

Answer 3

Trypsin. (activated with trypsinogen)

Question 4

What can happen if trypsinogen is activated too early

Answer 4

Can lead to acute pancreatitis
-Might happen due to injury to acinar cells or due to impaired secretion of proenzymes into duodenum (alcohol or gallstones)

Question 5

How does alcohol cause acute pancreatitis

Answer 5

Increased zymogen release from acinar cells. Can also cause decrease in fluids and bicarbonates in ducts. This mean pancreatic juices are thick and sludge-like which can block ducts and therefore distended ducts.

When this happens, digestive enzymes start breaking down pancreatic cells

Question 6

How do gallstones cause pancreatitis

Answer 6

Gallstones travel down bile duct and get lodged at sphincter of oddi and block it. This then leads to backing up of pancreatic juices

Question 7

Other causes of acute pancreatitis

Answer 7

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune (lupus)
Scorpion stings
Hypercalcaemia/hypertriglyceridaemia
ERCP
Drugs

Question 8

Symptoms of acute pancreatitis

Answer 8

N&V
Epigastric pain with radiation to back. Relieved by sitting forward

Bruising around periumbilical region

Bruising around flanks

signs of sepsis (tachycardia, fever, rigid abdomen, shock)

Question 9

Investigations for acute pancreatitis

Answer 9

Bloods:
amylase- elevated
Lipase- elevated

Bone profile- Hypercalcaemia
Triglycerides- Elevated

ABG:
Lactate (indicates sepsis) and Pao2

Xray
USS to confirm or exclude gallstones

Question 10

Management of acute pancreatitis

Answer 10

Fluids resuscitation 
Analgesis and antiemetics
NG tube
Adequate oxygenation
Antibiotics if evidence of infection
ERCP if gallstone

Question 11

Complications of acute pancreatitis

Answer 11

Pseudocysts
Necrosis
Abscess

Question 12

How does acute pancreatitis lead to necrosis

Answer 12

Inflammatory response by body causes blood vessels to become leaky and rupture leading to pancreatic tissue swelling

This causes premature activation of lipase which then starts to destroy peripancreatic fat

The fat and tissues liquefy and can start necrosing (liquefactive haemorrhage necrosis)

Question 13

How does acute pancreatitis lead to pseudocysts and abscess

How do these present

How to assess for pseudocysts/absess

Answer 13

Fibrous tissue surrounds necrotic tissues and fills with pancreatic juices

The pseudocyst can also become infected to become and abscess and presents as sepsis

This may cause Abdo pain, loss of appetite and a palpable tender mass

Abdo CT

Question 14

Systemic complications of acute pancreatitis

Answer 14

Hypovolaemic shock (due to rupture of blood vessels)

Disseminated intravascular coagulation (small blood clots form throughout body which use up all clotting factors)

Acute respiratory distress syndrome (The inflammation leads to lots of leaky blood vessels. This can happen in lungs and they can fill with fluid- making it hard to breathe