Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Acute pancreatitis is the sudden inflammation of the pancreas, which can range from mild discomfort to a severe, life-threatening illness.

Question 2

What are the two main types of acute pancreatitis?

Answer 2

Interstitial oedematous pancreatitis (most common, better prognosis) and necrotising pancreatitis (more severe, involves pancreatic tissue necrosis).

Question 3

What is the prevalence of acute pancreatitis in the UK?

Answer 3

Approximately 56 cases per 100,000 annually.

Question 4

What are the most common causes of acute pancreatitis in the UK?

Answer 4

Gallstones and alcohol consumption.

Question 5

What mnemonic can help remember the causes of acute pancreatitis?

Answer 5

“I GET SMASHED”: Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps/malignancy, Autoimmune disease, Scorpion sting, Hypertriglyceridemia/Hypercalcaemia, ERCP, Drugs.

Question 6

What are common risk factors for acute pancreatitis (4)?

Answer 6

Male gender, increasing age, obesity, and smoking.

Question 7

What is the typical presentation of pain in acute pancreatitis?

Answer 7

Severe epigastric pain that may radiate to the back, often associated with nausea and vomiting.

Question 8

What past medical history is relevant in assessing acute pancreatitis?

Answer 8

History of gallstones, biliary disease, or previous episodes of pancreatitis.

Question 9

What social history factors are important in acute pancreatitis?

Answer 9

Alcohol intake and smoking habits.

Question 10

What are Cullen’s and Grey-Turner’s signs?

Answer 10

Cullen’s sign: periumbilical bruising; Grey-Turner’s sign: flank bruising; both may indicate severe pancreatitis with haemorrhage.

Question 11

What initial blood tests are important in suspected acute pancreatitis?

Answer 11

Serum amylase or lipase (typically elevated), liver function tests, calcium, triglycerides, and full blood count.

Question 12

What imaging modality is commonly used to assess acute pancreatitis?

Answer 12

Abdominal ultrasound to identify gallstones and assess the pancreas.

Question 13

What criteria are used to assess the severity of acute pancreatitis?

Answer 13

Glasgow-Imrie criteria, Ranson’s criteria, and APACHE II score.

Question 14

What is the first-line management for acute pancreatitis?

Answer 14

Supportive care including intravenous fluids, analgesia, and monitoring for complications.

Question 15

When are antibiotics indicated in acute pancreatitis?

Answer 15

Antibiotics are not routinely indicated unless there is evidence of infected pancreatic necrosis or other infections.

Question 16

What is a common local complication of acute pancreatitis?

Answer 16

Pancreatic pseudocyst formation.

Question 17

What systemic complications can arise from acute pancreatitis?

Answer 17

Acute respiratory distress syndrome (ARDS), renal failure, and disseminated intravascular coagulation (DIC).

Question 18

What lifestyle modification can reduce the risk of recurrent acute pancreatitis?

Answer 18

Abstaining from alcohol and smoking cessation.

Question 19

What is the role of endoscopic retrograde cholangiopancreatography (ERCP) in acute pancreatitis?

Answer 19

ERCP is indicated in cases of gallstone pancreatitis with cholangitis or persistent bile duct obstruction.

Question 20

What is the mortality rate for severe acute pancreatitis?

Answer 20

Approximately 15%.

Question 21

What is the significance of elevated serum lipase in acute pancreatitis?

Answer 21

Elevated serum lipase is more specific and remains elevated longer than amylase in acute pancreatitis.

Question 22

What dietary recommendations are made during recovery from acute pancreatitis?

Answer 22

Early enteral nutrition is encouraged once the patient is stable, starting with a low-fat diet.

Question 23

What is the potential outcome of recurrent acute pancreatitis?

Answer 23

Development of chronic pancreatitis.

Question 24

What is the importance of monitoring serum calcium in acute pancreatitis?

Answer 24

Hypocalcaemia can occur due to fat saponification and is associated with severe disease.

Question 25

What surgical intervention may be necessary in gallstone-induced acute pancreatitis?

Answer 25

Cholecystectomy to prevent recurrence.