Pancreatitis

Question 1

What is pancreatitis?

Answer 1

Inflammation of the pancreas (acute or chronic)

Question 2

What is acute pancreatitis?

Answer 2

Sudden & short-lived inflammation of the pancreas - normal function returns after inflammation goes away - can cause long-term complications

Question 3

What is chronic pancreatitis?

Answer 3

Long-lasting inflammation - periodically symptomatic - permanent damage of the pancreas - scarring

Question 4

Symptoms of acute pancreatitis

Answer 4

Sudden severe pains & cramps in the abdomen, nausea/emesis, diarrhoea, fever, indigestion, jaundice, tachycardia

Question 5

Aetiology of acute pancreatitis

Answer 5

Gallstones, excessive alcohol consumption

Question 6

How are gallstones formed?

Answer 6

Bile in the gallbladder hardens into a stone-like material due to high cholesterol, bile salts, and/or bilirubin

Question 7

What is it called when gallstones are present in the gallbladder?

Answer 7

Cholelithiasis

Question 8

What is it called when gallstones are present in the bile duct?

Answer 8

Choledocholithiasis

Question 9

What are the two main types of gallstones?

Answer 9

Cholesterol stones & pigment stones

Question 10

How do cholesterol stones form?

Answer 10

Bile is oversaturated with cholesterol - decrease in bile production or increase in cholesterol consumption

Question 11

How are pigment stones formed?

Answer 11

Disruption of bilirubin by bacterial enzymes - calcium product formed - forms stones - higher risk if you suffer from liver disease, obesity, chronic alcoholic

Question 12

Treatment of Gallstones

Answer 12

Oral dissolution therapy (drink) (cholesterol stones) -recurs in >50% in 5 years
Keyhole surgery - removal of connection between gallbladder, bile ducts, & liver

Question 13

Chronic alcohol consumption and acute pancreatitis

Answer 13

Cause 17-25% cases of acute pancreatitis, usually people who drink >5 units of alcohol daily for 5 years, alcohol affects acinar cells & small pancreatic ducts, cause precipitation and increase viscosity of pancreatic secretions, protein plugs develop in small ducts -> calculi -> inflammation & fibrosis -> chronic pancreatitis - leads to premature activation of pancreatic enzymes (autodigestion)

Question 14

Diagnosis of acute pancreatitis

Answer 14

Serum amylase and lipase analysis, CT scans, endoscopy, clinical presentations (abdomen pain e.g. tenderness & palpitations)
-Alcohol-related acute pancreatitis ~ liver panel tests, calcium determination and triglyceride measurement

Question 15

Treatment of acute pancreatitis

Answer 15

IV treatment for dehydration, Oxygen via ventilation, painkillers, antibiotics, liquid diet, treat gallstones & other symptoms

Question 16

What causes acute pancreatitis to become chronic pancreatitis?

Answer 16

Fibrosis, calcification, inflammation of ducts, & repeated incidence of acute pancreatitis

Question 17

Symptoms of chronic pancreatitis

Answer 17

Emesis, a dull relentless to a more severe abdomen pain, epigastric tenderness, unexplained weight loss, steatorrhoea, glucose intolerance

Question 18

Diagnosis of chronic pancreatitis

Answer 18

Serum enzymes (not as much of an increase as acute pancreatitis), determination of DM status, x-ray, exocrine function test using endoscopy

Question 19

Complications of chronic pancreatitis

Answer 19

Related to fat malabsorption, malnutrition, DM (80% of patients due to damage of pancreas) , biliary obstruction (scaring of bile ducts), pseudocysts (build up of pancreatic juices outside ducts), duodenal obstruction, pancreatic fistula (abnormal opening from pancreas to pancreatic duct), & pancreatic ascites (collection of pancreatic fluid in abdomen)

Question 20

Pathogenesis of chronic pancreatitis

Answer 20

Replacement of healthy pancreatic tissue with fibrotic tissue - sessions begin in exocrine glands before attacking islets - development of calcium and protein stones (lithiasis)

Question 21

Risk factors for chronic pancreatitis

Answer 21

High continuous alcohol consumption, high protein & fat diet, tobacco consumption, intergenerational malnutrition

Question 22

Non-surgical treatment of chronic pancreatitis

Answer 22

Pain relief, enzyme therapy to stop diarrhoea & help weight gain, high protein & calorie diet, nerve treatment, stents to open narrow areas, surgery to remove stones

Question 23

Surgical treatment of chronic pancreatitis

Answer 23

Longitudinal pancreaticojejunostomy (clear blocked pancreatic duct), remove pancreas and autotransplantation of islet cells to the liver, Whipple procedure (partial removal of pancreas, duodenum, part of the bile duct, the gall bladder, & maybe part of the stomach ~ the surgeon then connects the remaining organs), & partial removal of pancreas