Pancreatitis

Question 1

What is pancreatitis

Answer 1

Inflammation of the pancreas which can be acute or chronic

Question 2

Causes of pancreatitis

Answer 2

Gallstones, alcohol, post-ERCP

Question 3

Symptoms of acute pancreatitis

Answer 3

Rapid onset of inflammation and symptoms

Question 4

Symptoms of chronic pancreatitis

Answer 4

Longer-term inflammation and symptoms with a progressive and permanent deterioration

Question 5

How do gallstones cause pancreatitis

Answer 5

Gallstones getting trapped at the end of the biliary system blocking the flow of bile and pancreatic juice into the duodenum

Question 6

Who is gallstone pancreatitis more common in

Answer 6

Women and older patients

Question 7

How does alcohol cause pancreatitis

Answer 7

It is directly toxic to pancreatic cells resulting in inflammation

Question 8

I GET SMASHED mnemonic for remembering causes of pancreatitis

Answer 8

Idiopathic, gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion sting, hyperlipidaemia, ERCP, drugs

Question 9

Which drugs can cause pancreatitis

Answer 9

Furosemide, thiazide diuretics and azathioprine

Question 10

Presentation of acute pancreatitis

Answer 10

Severe epigastric pain, radiating to the back, abdominal tenderness, systemically unwell, associated vomiting

Question 11

How is acute pancreatitis diagnosed

Answer 11

Clinical diagnosis based on presenting features and amylase level

Question 12

Investigations needed for the Glasgow Score

Answer 12

FBC, U&E, LFT, calcium, ABG

Question 13

What does the Glasgow score do

Answer 13

Assess the severity of pancreatitis

Question 14

What is the level of amylase in acute compared to chronic pancreatits

Answer 14

Raised more than 3x the upper limit in acute, but it chronic it may not rise because pancreas has reduced function

Question 15

What is the importance of the lipase levels

Answer 15

Raised in acute pancreatitis, considered more sensitive and specific than amylase

Question 16

Criteria for Glasgow score (PANCREAS)

Answer 16

PaO <8 kPA
Age >55
Neutrophils >15
Calcium <2
Urea >16
Enzymes (LDH >600 / AST/ALT >200)
Albumin <32
Sugar >10

Question 17

Management of acute pancreatitis

Answer 17

IV fluids, nil by mouth, analgesia, treatment of cause, compications and Abx if infection

Question 18

Complications of acute pancreatitis

Answer 18

Necrosis, infection, abscess, acute peripancreatic fluid collections, pseudocysts, chronic pancreatitis

Question 19

Presentation of chronic pancreatitis

Answer 19

Similar symptoms to acute pancreatitis but less intense and longer lasting

Question 20

Complications of chronic pancreatitis

Answer 20

Chronic epigastric pain, loss of exocrine function, loss of endocrine function, damage and strictures to the duct system, formation of pseudocysts or abscesses

Question 21

What can loss of endocrine function cause

Answer 21

Diabetes

Question 22

What can loss of exocrine function cause

Answer 22

LAck of pancreatic enzymes such as lipase

Question 23

Management of chronic pancreatitis

Answer 23

No alcohol or smoking, analgesia, replacement of pancreatic enzymes (Creon), SC insulin, ERCP with stening, surgery

Question 24

When is surgery indicated in pancreatitis

Answer 24

Severe chronic pain, obstruction to biliary system and pancreatic duct, pseudocysts, abscesses

Question 25

Drug causes of pancreatitis (FAT SHEEP)

Answer 25

Ferusemide, azithioprine/asparaginase, thiazides/tetracyclines, statins/sulfonamides/sodium valproate, hydrochlorothiazide, ethanol, eostrogens, protease inhibitors and NRTIs