Pancreatitis

Question 1

Acute Pancreatitis

Answer 1

secondary to gallstone disease or excess alcohol consumption

Question 2

Risk factors

Answer 2

Gallstone
Ethanol (alcohol)
Trauma
Steroids
Mumps infection / Coxsackie virus
Autoimmune disease (Ig4 related: SLE or Sjogren's syndrome)
Scorpion bite
Hypercalcemia (hyperparathyroidism)
ERCP history
Drugs (oestrogen containing contraceptives)

hyperlipidemia
pancreatic carcinoma
hereditary

Question 3

Clinical features

Answer 3

S: epigastric pain then spreading to the whole abdomen
O: sudden in onset
C: -
R: radiating to the back
A: nausea, vomiting, abdominal distension
T: after heavy fatty meals
E: relief by sitting and leaning forwards, aggravated by movements
S: severe

Question 4

Physical examinaion

Answer 4

patient lying due to pain and looks pale and sweating
mild jaundice
tachycardia

tenderness and guarding around the abdomen
abdominal distension
abdomen not move with distension
absent of bowel sounds

rare:
Cullen’s sign: bruising around the umbilicus
Grey Turner’s sign: bruising in the flanks

Question 5

Investigations

Answer 5

FBC:

• Hb
• Hct: >0.47 on admission is measure of severe disease
• WCC (leucocytosis)

Serum amylase: raised 3X is diagnostic (>1000u/L)
Serum lipase elevated (more specific than amylase)
Compulsory to do urinalysis as serum amylase is not useful after 40hours of pain.

LFT:
bilirubin increase
ALT increase

Serum calcium: reduce due to saponification
BUSE: loof for dehydration
Blood sugar: hyperglycemia due to the damage of islet of Langerhans with insulin production interferes
ABG: PO2 reduce

AXR: psoas shadows, sentinel loop sign
CXR: look for small pleural effusion or signs of ARDS
TAUS: look for gallstones, bile duct dilatation
CT TAP: pancreatic oedema and swelling and necrosis (diagnostic uncertainty and confirmation)

Question 6

Management

Answer 6

no curative but supportvie measures:
1. IV fluids resuscitation and oxygen therapy, cyrstalloid should be used
2. Keep Nil by mouth
3. IV analgesics
4. Correction of electrolyte imbalance and metabolic imbalance
5. NG tube for enteral feeding
6, Catheterization for hourly urine output (at least >0.5ml/kg/hr)
7. Stress ulcer prophylaxis by giving PPIs
8. Organ support:
-vasopressors, calcium gluconate for hypoglycaemia
- intubation and ventilation for ARDS
-dialysis for ARF
9. antibiotics given when signs of sepsis related to pancreatitis (infected pancreatic necrosis / peripancreatic collections)

Question 7

Complications

Answer 7

Systemic:
DIC
ARDS
ARF
Hypocalcemia
Hyperglycemia (diabetes)

Local:
Pancreatic necrosis
Pancreatic abscess
Pancreatic pseudocyst
chronic pancreatitis