Pancreatitis

Question 1

Ranson criteria

Answer 1

1. On Admission 
WBC count >16 000
Glucose >200mg/dL
Age >55y
AST >250
LDH >350

2. Subsequent 48h
   Hematocrit fall 10%
   Calcium 6L required
   Base excess +4, P02

Question 2

Imaging when pancreatitis diagnosis in question

Answer 2

Contrast enhanced CT

Question 3

If necrosis seen on CT, what should be started

Answer 3

Prophylactic antibiotics

50% will become infected.

Question 4

Following resolution of pancreatitis, what should be done if the person has gall stones

Answer 4

Cholecystectomy

Question 5

Initial assessment

Answer 5

1. Take history (SOCRATES), AMPLE
2. Check for risk factors
   Gall stones
   Ethanol
   Trauma
   Steroids and diabetes
   Mump/other viral
   A
   Scoripion
   Hyperlipidemia, hypercalcemia
   ERCP
   Drugs- azathioprine, thiazide
3. Examination: fever, pulse, BP. Abdominal pain/tender, pleural effusions, pericardial
4. Ix
   FBC->anemia, DIC, WCC
   UEC->+Cr is poor prognosis
   LFTs->obstruction
   Amylase, lipase elevated 3X ULN
   CMP
   Glucose
   INR
   ABG->hypoxemia, acidosis
   CXR->atelectasis, pleural effusio
   AXR->sentinel loop (isolated dilitation of segment of gut adjacent to pancreas)
   USS->pancreatic inflammation, stranding, calcifications
   Non-contrast CT abdomen, MRCP, ERCP?

Question 6

Management

Answer 6

1. ABC
2. Ventilate Oxygen
3. Cannula
4. IVF resuscitation->bolus, or 1L over hour
5. Morphine + metoclopramide
6. Insert catheter, monitor urine output
7. Continuous monitoring
8. Get surgical, medical help
9. LMWH DVT, TEDs
10. Monitor UEC, amylase, VBGs, glucose daily. Hourly BO, u/o
11. Abdominal USS (gall stones), CT (necrosis)
12. Nutrition
13. Evidence of necrosis->prophylactic antibiotics
14. If glucose ++, place on sliding scale
15. If bleeding, check parametes
16. Consider calcium and magnesium replacement

Question 7

Modified glasgow criteria

Answer 7

PANCREAS
Pa02 (need ABG)
Age >55
Neutrophilia (FBC w/ differentials)
Renal function (UECs)
Enzymes (LFTs, LDH)
Albumin
Sugar (+Glucose)

Question 8

Early complications

Answer 8

Shock
ARDS
Renal failure
DIC
Sepsis
Hypocalcemia
Hyperglycemia

Question 9

Late complications

Answer 9

1. Pancreatic necrosis and psuedocyst= +T, mass, persistent amylase/LFTs->may need drainage
2. Abscesses->drain
3. Bleeding->embolise
4. Thrombosis
5. Fistulae
6. Recurrent edematous panxreatitis

Question 10

Examination

Answer 10

1. Evidence of hypovolemia
2. Diaphoretic, tachyP, tachyC
3. -ve breath sounds, effusion
4. Tender abdomen, reduced bowel sound
5. SIgns of hypocalcemia rare->facial muscle spasm with Chvosteks sign and carpopedal spasm with Trousseau’s sign
6. Cullens signs, Grey turners sign