Pancreatitis

Question 1

Name of diagnostic criteria and features for diagnosis of acute pancreatitis

Answer 1

Revised Atlanta Criteria (2012)
Two of: typical pain, lipase x3 ULN, imaging features of pancreatitis

Question 2

What percentage have mild vs. severe disease?

Answer 2

80% have mild disease
20% have moderate to severe disease

Question 3

What is the mortality associated with:
mild disease
severe disease

Answer 3

<1%
15-35%

Question 4

What are the common causes of pancreatitis?
Less common

Answer 4

Common: gall stones (40-50%), alcohol (20%), idiopathic (20%)
Less common: medications, ERCP, trigs, IgG4 disease, mumps, trauma, surgery

Question 5

What scoring systems are used to predict disease severity?
What percentage of those predicted to have severe disease go on to develop it?
What percentage of those predicted to have mild disease go on to have severe disease?

Answer 5

1. APACHE 2, modified glasgow / imrie score, Ranson score, SIRS
2. 50%
3. almost none

Question 6

Management for pancreatitis

Answer 6

1. fluid resus
2. nutrition - PO as tolerated, NG/NJ if inadequate intake at 3-5 days
3. Abx if evidence of secondary infection
4. Analgaesia
5. Surgery

Question 7

What percentage of people develop recurrent pancreatitis?
What percentage of people develop chronic pancreatitis?

Answer 7

1. 20%
2. 10-15%

Question 8

What defines chronic pancreatitis?
What testing is used?

Answer 8

permanent structural damage, impaired exocrine and endocrine function
faecal elastase

Question 9

What are some inherited forms of pancreatitis?

Answer 9

Hereditary pancretatitis
Cystic fibrosis
SPINK1 mutation
Varian common chromtrypsin C
Autoimmune pancreatitis

Question 10

Hereditary pancreatitis
- protein involved
- mode of inheritance
- risk of cancer

Answer 10

trypsinogen
autosomal dominant, 80% penetrance
increased risk of cancer

Question 11

What is management for pancreatitis with:
- fluid collection
- pseudocyst
- walled off necrosis

Answer 11

• delay (watch and wait)
• drain
• debride

Question 12

Pancreatic cysts types, mucin producing?, premalignant?, location?

Answer 12

Serous cystadenoma, located in head of pancreas, dont produce mucin, not premalignant
IPMN, head of pancreas, produce mucin, pre-malignant
MCN, body or tail of pancreas, produce mucin, pre-malignant