Pancreatitis

Question 1

What are the causes of pancreatitis?

Answer 1

I GET SMASHED
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, azathioprine

Question 2

How does it present?

Answer 2

Severe epigastric pain
Radiates through to the back
Vomiting
Abdo tenderness
Systemically unwell

Question 3

What investigations would you do?

Answer 3

Routine bloods
Amylase
Lipase
CRP
USS
CT abdomen

Question 4

Which is more accurate amylase or lipase?

Answer 4

lipase

Question 5

What score is used to assess the severity of pancreatitis ?
Give the criteria
What is a mild, moderate and severe score

Answer 5

Glasgow
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

0-1 - mild
2 - moderate
3 or more - severe

Question 6

What is management?

Answer 6

ABCDE
IVI
NBM
Analgesia
Treatment of underlying causes
Consider admission to HDU/ICU

Question 7

What are complications of acute pancreatitis?

Answer 7

Necrosis
Infection of necrotic area
Abscess
Acute peri pancreatic fluid collections
Pseudocysts
Chronic pancreatitis

Question 8

What is the most common cause of chronic pancreatitis

Answer 8

Alcohol

Question 9

What are complications of chronic pancreatitis

Answer 9

Chronic epigastric pain
Loss of exocrine function
Loss of endocrine function - lack of insulin -> diabetes
Damage and strictures to the duct system
Pseudocysts and abscesses

Question 10

What is the management of chronic pancreatitis?

Answer 10

abstain from alcohol and smoking
Analgesia
Replacement of pancreatic enzymes - Creon
Subcut insulin
ERCP w stent if strictures
Surgery if necessary