Pancreatitis

Question 1

Definition of pancreatitis

Answer 1

Pancreatitis is inflammation of the pancreas, acute pancreatitis can return to normal after resolution of the episode, conversely chronic pancreatitis, is continuing inflammation with irreversible structural changes f

Question 2

Causes of acute pancreatitis

Answer 2

Gallstones -95%

Ethanol -95%

Traum

Steroids

Mumps

Autoimmune

Scorpian venoma

Hyperlipidaemia

ERCP

Drugs

Question 3

Symptoms of acute pancreatitis

Answer 3

Gradual or severe sudden epigastric pain or central abdominal pain that radiates to the back (sitting forward may relive)

Question 4

Signs of acute pancreatitis

Answer 4

May be mild in serious disease

• tachycardia
• fever
• jaunice
• shock
• local/generalise tenderness
• periumbillical bruising - Cullens signs
• Grey turners sign - flank pain from blood vessel autodigestion and retroperitoneal haemorrhage

Question 5

Test for acute pancreatitis

Answer 5

• raised serum amylase (3 fold the upper limit)
• serum lipase more specific for pancreatitis
• ABG- monitor oxgenation
• AXR- no psoas shadowing
• erect CXR - helps exclude other causes
• CT - standard choice of imaging to assess severity and complications
• Ultrasound if gallstones
• ERCP if LFTS worsen

Question 6

Assessing severity

Answer 6

Modified Glasgow criteria

3 or > positive factors detected within 48 hours of onset suggests severe pancreatitis

Pa02 - <8pka

Age>55 years

Neutrophillia WBC >15 x10(

Calcium <2mmol/l

Renal function urea >16 mmol/l

Enzmes LDH>600i/l

Albumin <32g/l

Sugar - blood glucose >10mmol/l

Question 7

Management of acute pancreatitis

Answer 7

• Nothing by mouth
• Give IV saline 0.9% until vital signs are steady and urine flow is at>30ml/hr
• Analgesia: penthidine 75-100mcg or morphine
• Hourly Pulse, BP and urine output
• If worsening ITU, oxygen, if PaO2 down

Question 8

Indications for surgery in chronic pancreatitis

Answer 8

• treatment of reversable causes (anatomical abno, tumours, cysts, ductal stricture)
  
  • Whipples procedure- pancreaticoduodenectomy
  • partial panceatomy of head (frey procedure) or tail (distal pancreatectomy)
  • Pancreaticojejunostomy (duval procedure)
• treatment of severe intractable pain or multiple relapses
  
  • freys or tail procesdure
  • total pnacreatection
• complications (psuedocyst, obstruction, fistula, infection, portal hypertension)

Question 9

Treatment of chronic pancreatitis

Answer 9

• prevention of cause
  
  • stop alcohol, deal with gallstnes, treat autoimmune dsease
  • a diet rich in antioxidants
• control symptoms/complications
  
  • dietary modifications -adequate carbohydrates and prtein
  • pancreatic enxyme supplements
  • analgesia
  • control of diabetes often requires insulin