Pancreatitis

Question 1

What is the difference between acute and chronic pancreatitis

Answer 1

Acute
Rapid onset, normal function usually returns

Chronic
Long-term inflammation and symptoms
Progressive and permanent deterioration in function

Question 2

What are the 3 key causes of pancreatitis?

Answer 2

Gallstones
Alcohol
Post-ERCP

Question 3

What is the pathophysiology of gallstone pancreatitis?

Answer 3

Gallstones trapped at the end of the biliary system

Bile and pancreatic juice flow into duodenum blocked

Reflux of bile into pancreatic duct

Pancreatic juice contains enzymes

Results in inflammation in the pancreas

Women
Older patients

Question 4

How does alcohol cause acute pancreatitis?

Answer 4

Alcohol directly toxic to pancreatic cells

Causes inflammation

Men
Younger patients

Question 5

How do you remember the majority of causes of pancreatitis?

Answer 5

Idiopathic

Gallstones
Ethanol
Trauma

Scorpion sting
Mumps
Autoimmune
Steroids
Hyperlipidaemia
ERCP
Drugs (furosemide, thiazide diuretics and azathioprine)

Question 6

How does acute pancreatitis present?

Answer 6

Severe epigastric pain

Radiating through to the back

Vomiting

Abdominal tenderness

Systemically unwell

Question 7

What scoring system is used to assess the severity of pancreatitis?

Answer 7

Glasgow score

Question 8

What is required for calculating a Glasgow score?

Answer 8

FBC (white cell count)
U&Es (urea)
LFT
Calcium
ABG

Question 9

What is raised in acute pancreatitis?

Answer 9

Amylase, more than 3 times upper limit
(chronic may not rise due to decreased function)

Lipase (more sensitive and specific than amylase)

CRP

Question 10

What imaging is used for pancreatitis?

Answer 10

Ultrasound
CT abdomen (for complications of pancreatitis)

Question 11

What do different Glasgow scores mean?

Answer 11

0 or 1- mild pancreatitis

2- moderate pancreatitis

3 or more - severe pancreatitis

Question 12

What mnemonic is used for Glasgow score?

Answer 12

Pao2 < 8KPa

Age > 55

Neutrophils (WBC > 15)

Calcium < 2

uRea > 16

Enzymes ( LDH > 600 or AST/ALT > 200)

Albumin < 32

Sugar (glucose > 10)

Question 13

How is acute pancreatitis managed?

Answer 13

ICU

IV fluids
NbM
Analgesia
ERCP for gallstones
Antibiotics
Complication treatment

Improvement in 3-7 days

Question 14

What are the 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) 4 weeks after
• Chronic pancreatitis

Question 15

What does chronic pancreatitis result in?

Answer 15

Fibrosis and reduced pancreatic function

Question 16

What is the most common cause of chronic pancreatitis?

Answer 16

Alcohol

Question 17

What are the key complications of chronic pancreatitis?

Answer 17

Chronic epigastric pain

Loss of exocrine function
- Lack of pancreatic enzymes secreted into GI tract

Loss of endocrine function
- Lack of insulin, leading to diabetes

Damage and strictures to duct system
- Obstruction in excretion of pancreatic juice and bile

Pseudocyst or abscess formation

Question 18

How is chronic pancreatitis managed?

Answer 18

No alcohol or smoking

Analgesia

Replacement pancreatic enzymes (Creon) e.g. lipase (can lead to steatorrhea) and deficiency in fat soluble vitamins (ADEK)

Subcutaneous insulin

ERCP with stenting (for obstructions)

Surgery