Pancreatitis

Question 1

What are the causes of pancreatitis?

Answer 1

• Idiopathic
• Gallstones
• Ethanol
• Trauma
• Steroids
• Measles/mumps/malignancy
• Autoimmune
• Scorpion/spider bites
• Hyperlipid/calcaemia
• ERCP/emboli
• Drugs (azathioprine/tetracyclines/oestrogens)

Question 2

What are the symptoms and signs on presentation that would normally be present in a patient with pancreatitis?

Answer 2

• Sudden central epigastric pain radiating to the back
  
  • May be relieved by sitting forward
• Nausea and vomiting
• Tachycardia (hypovolaemia from third space effusion)
• Fever/jaundice/ileus sometimes present

Question 3

What investigative workup might be required for a patient with suspected pancreatitis?

Answer 3

• Lipase (sometimes amylase)
• CXR (exclude other causes of pain)
• Ultrasound (exclude gallstones)

Question 4

What are the management prinicples for apatient with suspected pancreatitis?

Answer 4

• Reduce vomiting/third space shifts
  
  • Nil by mouth - fluids
• Analgesia
• Treatment of cause
  
  • ERCP, cholecystectomy etc.