Pancreatitis

Question 1

what is the atlanta criteria for acute pancreatitis?

Answer 1

• mild: no organ dysfunction/complications, resolves normally within a week
• moderate: initially some evidence of organ failure which improves within 48 hours
• severe: persistent organ dysfunction for greater than 48 hours, together with local or systemic complications

Question 2

what are the two principal causes of acute pancreatitis?

Answer 2

• gallstones
• alcohol

Question 3

what are the causes of acute pancreatitis?

Answer 3

I GET SMASHED

• idiopathic
• gallstones
• ethanol
• trauma
• steroids
• mumps/malignancy
• autoimmune
• scorpion sting
• hypertriglyceridaemia/hypercalcaemia
• ERCP
• drugs (e.g. azathioprine, thiazides, septrin, tetracyclines)

Question 4

what causes inflammation in acute pancreatitis?

Answer 4

hypersecretion or backflow (due to obstruction) of exocrine digestive enzymes, which results in autodigestion of the pancreas

Question 5

how is pancreatic damage classified in acute and chronic pancreatitis?

Answer 5

acute pancreatitis damage is potentially reversible and classified into:
- interstitial oedematous pancreatitis
- necrotising pancreatitis

chronic pancreatitis involves ongoing inflammation that causes irreversible damage to the pancreas

Question 6

what are the symptoms of acute pancreatitis?

Answer 6

• severe, sudden-onset epigastric pain, which may radiate to the back
• abdominal distension
• nausea
• vomiting
• ? reduced bowel sounds
• ? cullen’s sign/grey-turner’s sign

Question 7

what are the criteria for diagnosing acute pancreatitis?

Answer 7

two of the following three criteria must be satisfied:

• abdominal pain plus a history suggestive of acute pancreatitis
• serum amylase/lipase >3 X ULN
• imaging findings characteristic of acute pancreatitis

Question 8

why should an ECG be performed for all patients presenting with epigastric pain?

Answer 8

to rule out myocardial infarction that may masquerade as epigastric pain

Question 9

when is a CT-AP typically performed in patients with acute pancreatitis, and what does it assess?

Answer 9

• CT-AP is typically performed 48-72 hours after the initial presentation if patients do not clinically improve
• it provides optimal imaging of the pancreas and is used to assess for pancreatic necrosis or other complications

Question 10

what is the glasgow-imrie score?

Answer 10

used to assess the severity of acute pancreatitis

PANCREAS

• PaO2 <7.9
• age >55
• neutrophils (e.g. WCC) >15
• calcium <2.0
• renal (e.g. urea) >16 mmol/L
• enzymes (e.g. LDH) >600 IU/L
• albumin <32 g/L
• sugar (e.g. glucose) >10 mmol/L

severe pancreatitis is indicated by a score of 3 or more

Question 11

what is the management of gallstone pancreatitis?

Answer 11

• ERCP +/- sphincterotomy
• cholecystectomy

Question 12

what are the long-term complications of acute pancreatitis?

Answer 12

• necrotising pancreatitis
• infected pancreatic necrosis
• pancreatic abscess
• ARDS
• pancreatic pseudocyst
• portal vein/splenic thrombosis
• chronic pancreatitis
• pancreatic insufficiency

Question 13

what is systemic inflammatory response syndrome (SIRS) in the context of acute pancreatitis, and how can it lead to ARDS?

Answer 13

SIRS is an inflammatory state affecting the body, triggered by acute pancreatitis. it is characterised by:
- fever
- tachycardia
- tachypnoea
- leucocytosis

ARDS can develop as a complication of SIRS due to:
- inflammatory mediators causing injury to lung endothelial cells
- increased pulmonary vascular permeability, leading to pulmonary oedema
- impaired gas exchange and oxygenation, resulting in respiratory failure