Pancreatitis

Question 1

Describe the pathophysiology of pancreatitis

Answer 1

autodigestion of pancreatic tissue by the pancreatic enzymes
=> leading to necrosis

Question 2

Clinical features of pancreatitis

Answer 2

• severe epigastric pain radiating to back
• vomiting

Question 3

What are the names given to Peri-umbilical discolouratino and flank discolouration which may be seen in pancreatitis?

Answer 3

periumbilical = Cullen’s sign

flank = Grey-Turner’s sign

Question 4

What blood test is usually raised in pancreatitis?

Answer 4

serum amylase
- sensitivity ~75%
- specificity 90%
- usually >3 times upper limit of normal

Question 5

Other causes of raised amylase?

Answer 5

pancreatic pseudocyst
mesenteric infarct
perforated viscus
acute cholecystitis
diabetic ketoacidosis (DKA)

Question 6

When can serum lipase be used instead of serum amylase?

Answer 6

longer half-life

=> useful for late presentations >24 hours

Question 7

A diagnosis of acute pancreatitis can be made clinically, without imaging. TRUE/FALSE?

Answer 7

TRUE

Question 8

What is US imaging used pancreatitis

Answer 8

assess the aetiology
e.g. gallstones/biliary obstruction

Question 9

What are the two most common causes of pancreatitis?

Answer 9

Gallstones
Alcohol

Question 10

Name some scoring systems used to identify those in need of critical care management

Answer 10

Ranson score
Glasgow score
APACHE II.

Question 11

What categories commonly indicate severe pancreatitis

Answer 11

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

Question 12

List the causes of pancreatitis

Answer 12

GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine, bendroflumethiazide, furosemide steroids, sodium valproate)

Question 13

Local complications of pancreatitis

Answer 13

• Peripancreatic fluid collection
• Pseudocysts
• Necrosis
• Abscess
• Haemorrhage

Question 14

How long after an attack of pancreatitis do pseudocysts usually occur?

Answer 14

4 weeks

Question 15

Describe the location of most pancreatic pseudocysts

Answer 15

retrogastric

Question 16

Describe the amylase in patient with a pancreatic pseudocyst

Answer 16

persistently mildly elevated

Question 17

What imaging can be used to assess for pancreatic pseudocysts?

Answer 17

CT
ERCP
MRI
endoscopic USS

Question 18

Definitive tx of pseudocysts

Answer 18

endoscopic or surgical cystogastrostomy or aspiration

Question 19

Why do we not drain peripancreatic fluid collections?

Answer 19

Most will resolve
can introduce infection

Question 20

What clinical sign may be present if a retroperitoineal haemorrhage has occurred after an attack of pancreatitis?

Answer 20

Grey-Turners sign (flank bruising)

Question 21

Main causes of chronic pancreatitis

Answer 21

Genetic:
- cystic fibrosis
- haemochromatosis

Ductal obstruction:
- tumour
- stones
- structural abnormalities (pancreas divisum and annular pancreas)

Question 22

Clinical features of chronic pancreatitis?

Answer 22

pain worse 15 to 30 minutes following a meal

steatorrhoea

diabetes mellitus late to develop

Question 23

Imaging of chronic pancreatitis

Answer 23

AXR shows pancreatic calcification in 30%

CT is more sensitive

Question 24

What investiagtion can be used if imaging is inconclusive for a diagnosis of chronic pancreatitis

Answer 24

faecal elastase
- used to assess exocrine function

Question 25

Management of chronic pancreatitis

Answer 25

• pancreatic enzyme supplements
• analgesia
• ?antioxidants