Pancreatitis

Question 1

What component of pancreatic juice do acinar cells produce?

Answer 1

Low volume, viscous, enzyme rich juice.

Question 2

What component of pancreatic juice do centroacinar and duct cells produce?

Answer 2

High volume, watery, bicarbonate rich juice.

Question 3

Two types of pancreatitis?

Answer 3

Acute pancreatitis and chronic pancreatitis.

Question 4

What is acute pancreatitis?

Answer 4

Rapid onset inflammation of pancreas.

Question 5

What is chronic pancreatitis?

Answer 5

Long standing inflammation of pancreas. This leads to destruction of endocrine and exocrine tissue leading to fibrosis of pancreas.

Question 6

Common cause of acute pancreatitis?

Answer 6

Gallstone and alcohol.

Question 7

What procedure can cause acute pancreatitis?

Answer 7

Endoscopic retrograde cholangio pancreatography

Question 8

What drugs can cause acute pancreatitis?

Answer 8

S - Sulphonamides and steroids
A - Azothioprine
N - NSAIDS
D - Diuretics

Question 9

How do gallstone cause acute pancreatitis?

Answer 9

Gallstone gets stuck in the ampulla and bile can’t leave and so you get bile reflux. You also get pressure build up of pancreatic juice as it can’t leave the ampulla. Reflux of activated enzymes from duodenum if gall stone leaves ampulla into duodenum.

Question 10

How does alcohol cause acute pancreatitis?

Answer 10

Increased permeability of pancreatic duct epithelium and so enzymes diffuse into periductal interstitial tissue. Alcohol can precipitate proteins in the ducts that obstruct the duct and result in upstream pressure.

Question 11

How does premature, intracellular enzyme activation occur in pancreatitis?

Answer 11

Proenzymes and lysosomal proteases incorporated into same vesicles resulting in trypsin being activated and pancreatic enzymes being activated intracellularly.

Question 12

What does extracellular/intracellular activation of trypsin in pancreatitis result in?

Answer 12

Activation of elastase which causes vessel destruction and islet necrosis leading to bleeding and hyperglycemia. Activation of complement also causes vessel destruction. Activation of prothrombin leads to thrombosis which leads to ischaemia. Activation of phospholipase A2 leads to fat necrosis which leads to hypocalcemia. Activation of kallikrein leads to vasodilation and plasma exudation that can lead to shock.

Question 13

Types of acute pancreatitis?

Answer 13

Oedematous pancreatitis. Haemorrhagic pancreatitis. Necrotic pancreatitis.

Question 14

Why is necrotic pancreatitis dangerous?

Answer 14

Can get infected.

Question 15

Symptoms of acute pancreatitis?

Answer 15

Epigastric pain radiating to back. Vomiting. Fever.

Question 16

Key clinical signs of acute pancreatitis?

Answer 16

Tachycardia and hypotensive. Grey turner’s sign. Cullen’s sign.

Question 17

What is grey turner’s sign?

Answer 17

bruising in flanks.

Question 18

What is cullen’s sign?

Answer 18

Bruising around umbilicus.

Question 19

What other differential diagnosis of acute pancreatitis are there?

Answer 19

Peptic ulcer or ruptured abdominal aortic aneurysm.

Question 20

Biomarkers for acute pancreatitis?

Answer 20

Raised amylase. Raised lipase.

Question 21

Why would an ultrasound be done to test for acute pancreatitis?

Answer 21

To look for gallstones as cause for pancreatitis.

Question 22

If ultrasound can’t seen gallstone what investigations do you do?

Answer 22

MRCP and then ERCP.

Question 23

What CRP value suggests severe pancreatitis?

Answer 23

Greater than 200.

Question 24

What score suggests severe pancreatitis in modified glasgow criteria?

Answer 24

Score greater than 3 within 48 hours onset.

Question 25

Modified glasgow criteria?

Answer 25

P - PO2
A - Age > 55
N - Neutrophils/white cell count
C - Calcium
R - Renal urea
E - Enzymes (AST and LDH)
A - Albumin
S - Sugar > 10mmol/l

Question 26

Management of acute pancreatitis?

Answer 26

IV fluids and urine catheter along with fluid balance monitoring. Analgesia.

Question 27

Systemic complications of acute pancreatitis?

Answer 27

Systemic inflammatory response syndrome, acute renal failure, adult respiratory distress syndrome.

Question 28

Local complications of acute pancreatitis?

Answer 28

Pancreatic necrosis, pancreatic pseudocyst, haemorrhage, thrombosis.

Question 29

How to treat infected necrosis?

Answer 29

Antibiotics and percutaneous drainage.

Question 30

What is a pancreatic pseudocyst?

Answer 30

Peri pancreatic fluid collection in a fibrous capsule.

Question 31

How to treat pancreatic pseudocyst?

Answer 31

Puncturing posterior wall of stomach and inserting a stent.

Question 32

Chronic pancreatitis mechanism?

Answer 32

Alcohol abuse leads to a decrease in citrate and lithostatin concentration which result in calcium precipitation which leads to calcium deposition. This leads to epithelial lesions which leads to enzyme activation.