Pancreatitis

Question 1

Definition

Answer 1

Inflammation of the pancreas

Can occur as acute pancreatitis- meaning it appears suddenly and lasts for a few days

Acute pancreatitis:
– occurs in the backdrop of a normal pancreas and the pancreas returns functionally and structurally to normal after the attack
– it occurs as isolated or recurrent attacks

Chronic pancreatitis:
– there is continuous inflammation with irreversible structural changes.

Question 2

Aetiology

Answer 2

Acute pancreatitis:
– gallstones (common)
—- obstruction of pancreatic drainage at the ampulla by a stone or associated oedema
– alcohol (common)
—- alcohol can interfere with calcium homeostasis in pancreatic acinar cells
– infections (mumps)
– pancreatic tumours
– iatrogenic (post surgery)
– Drugs- corticosteroids, azathioprine
– can be idiopathic

Chronic pancreatitis:
– alcohol (common)
—- this is reported to be the only cause in 60-80% of cases
– tropical
– autoimmune (IgG4-related)
– can be idiopathic
– hereditary

Question 3

Risk factors

Answer 3

Excessive alcohol consumption

Cigarette smoking

Obesity

Diabetes

Family history of pancreatitis

Question 4

Clinical presentation

Answer 4

Usually epigastric or upper abdominal pain radiating through to the back
– associated with nausea and vomiting

Upper abdominal tenderness on physical examination with no system abnormalities (a time of presentation)

Severe disease on physical examination:
– pt may have tachycardia, hypotension, and may be oliguric
– widespread tenderness with guarding
– may have Cullens sign (ecchymoses around the umbilicus) or flanks sign
– may have features of jaundice or cholangitis

Acute pancreatitis symptoms:
– upper abdominal pain
– abdominal pain that radiates to your back
– tenderness when touching the abdomen
– fever
– rapid pulse
– nausea
– vomiting

Chronic pancreatitis sign and symptoms:
– upper abdominal pain
– pain that radiates through into the back
– abdominal pain that feels worse after eating
– losing weight without trying
– oily, smelly stools
– if chronic pancreatitis has been caused by alcohol, pain may be exacerbated with further alcohol consumption