Pancreatitis

Question 1

Causes of pancreatitis include?

Answer 1

I - idiopathic

G - gallstones
E - ethanol
T - trauma

S - Steroids
M - mumps
A - autoimmune
S - scorpion sting
H - hyperlipidaemia
E - ERCP
D - drugs (furosemide, thiazide diuretics and azathioprine)

Question 2

3 main causes of acute pancreatitis?

Answer 2

gallstones, alcohol, post-ERCP

Question 3

pathophysiology of how gallstones can cause pancreatitis?

Answer 3

• gallstones get trapped in the ampulla of Vater, blocking flow of bile and pancreatic juice into the duodenum
• reflux of bile into the pancreatic duct, results in inflammation in the pancreas
• more common in women and older patients.

Question 4

pathophysiology of how alcohol can cause pancreatitis?

Answer 4

• directly toxic to pancreatic cells → inflammation
• more common in men and younger patients

Question 5

Clinical presentation of acute pancreatitis?

Answer 5

• Severe epigastric pain
• Radiating through to the back
• Associated vomiting
• Abdominal tenderness
• Systemically unwell (e.g., low-grade fever and tachycardia)

Question 6

Initial investigations for suspected acute pancreatitis?

Answer 6

Initial investigations are required as with any presentation of an acute abdomen. Importantly these need to include those required for calculating the Glasgow score:

• FBC (for white cell count)
• U&E (for urea)
• LFT (for transaminases and albumin)
• Calcium
• ABG (for PaO2 and blood glucose)

Question 7

Glasgow score in acute pancreatitis?

Answer 7

to assess the severity of pancreatitis: it gives a numerical score based on how many of the key criteria are present:

0 or 1– mild pancreatitis
2– moderate pancreatitis
>3 – severe pancreatitis

criteria for the glasgow score (1 point for each answer):

P - PaO2 <8Kpa
A - Age >55
N - Neutrophils (WBC>15)
C - Calcium <2
R - uRea >16
E - Enzymes (LDH>600 or AT/ALT >200)
A - Albumin <32
S - Sugar (Glucose >10)

Question 8

Amylase in acute pancreatitis

Answer 8

raised more than 3x the upper limit of normal

Question 9

Lipase in acute pancreatitis?

Answer 9

raised - more sensitive and specific than amylase

Question 10

CRP in acute pancreatitis

Answer 10

can be used to monitor level of inflammation

Question 11

Ultrasound in acute pancreatitis?

Answer 11

initial investigation of choice in assessing for gallstones

Question 12

Is a CT abdomen used in acute pancreatitis?

Answer 12

assess for complications of pancreatitis (such as necrosis, abscesses and fluid collections)

it is usually not required unless complications are suspected (e.g. the patient is becoming more unwell)

Question 13

Treatment of acute pancreatitis?

Answer 13

• become unwell very rapidly
• moderate/severe → considered for management on the high dependecy unit (HDU) or ICU
• Initial resuscitation (ABCDE approach)
• IV fluids
• Nil by mouth
• Analgesia
• Careful monitoring
• Treatment of gallstones in gallstone pancreatitis (ERCP / cholecystectomy)
• Antibiotics if there is evidence of a specific infection (e.g., abscess or infected necrotic area)
• Treatment of complications (e.g., endoscopic or percutaneous drainage of large collections)

3-7 days improvement

Question 14

Complications of acute pancreatitis?

Answer 14

• Necrosis of the pancreas
• Infection in a necrotic area
• Abscess formation
• Acute peripancreatic fluid collections
• Pseudocysts (collections of pancreatic juice) can develop 4 weeks after acute pancreatitis
• Chronic pancreatitis

Question 15

common presentation: 40 year old man with a history of alcohol excess presents with severe _________ pain. serum _____ levels are elevated

Answer 15

Epigastic

Lipase

Question 16

What does a low calcium in the context of pancreatitis indicate?

Answer 16

The mechanism of hypocalcaemia in this context is unclear but there is a demonstrated increased mortality rate in patients presenting with hypocalcaemia compared to those with normal calcium levels.