Pancreatitis

Question 1

What are the characteristics of acute pancreatitis?

Answer 1

Develops suddenly

Affects a gland which is usually normal

Question 2

What are the characteristics of chronic pancreatitis?

Answer 2

Develops insidiously
Characterised by progressive fibrosis
Destruction of both exocrine and endocrin function

Question 3

What are the three most common causes of acute pancreatitis?

Answer 3

Gall stones
Alcohol
Idiopathic

Question 4

What are some causes of chronic pancreatitis?

Answer 4

AGITS
A - alchohol
G - genetics e.g. CF, HH
I - immune e.g. lymphoblastic sclerosiing pancreatitis
T - triglycerides high
S - structural abnormalities e.g tumour obstruction, pancrease divisum

Question 5

How would someone present in acute pancreatitis?

Answer 5

Epigastric pain which radiates to the back
May be helped by sitting forwards
Vomiting

Question 6

What are some other causes of acute pancreatitis?

Answer 6

G- gall stones
E- ethanol
T- trauma
S- steroids
M- mumps
A- autoimmune
S- scorpion bites
H- hyperlipidaemia
E- ERCP
D- drugs e.g. thiazides, azathioprine

Question 7

What are the differentials for epigastric pain?

Answer 7

Perforated DU
Mesenteric infarction
MI
AAA
Cholecystitis

Question 8

What investigations would you order for someone with pancreatitis?

Answer 8

Bloods - FBC, U+Es, LFTs, amylast, Ca2+, glucose, CRP
ABG
Urine dipstick
Imaging
- CXR
- AXR
- US (visualise gall stones)
- Contrast CT

Question 9

What is the treatment for acute pancreatitis?

Answer 9

Supportive treatment
- Reassess continuously
- Fluid resuscitation
- Pancreatic rest e.g. NBM, NGT if vomiting
- Analgesia
- Antibiotics
- Manage any complications e.g. alcohol detox, O2 in ARDS
ERCP and sphincterotomy if secondary to gallstones
Surgery for pseudocyst, cyst of abscess

Question 10

What would you see in the blood results for someone with acute pancreatitis?

Answer 10

Increased WCC
Increased amylase and lipase
U+Es: Dehydration and renal failure
Increase AST and LDH
Low Ca2+
CRP allows you to monitor the progress

Question 11

Define a pancreatic pseudocyst

Answer 11

Collection of pancreatic fluid in the lesser sac surrounding the pancreas, which is surrounded by granulation tissue.
Causes pressure symptoms e.g. jaundice, gastric outlet obstruction plus bleeding from blood vessel erosion
Occurs commonly in pancreatitis due to alcohol and is a late complication

Question 12

What is the presentation of someone with a pancreatic pseudocyst?

Answer 12

Persisting abdominal pain 4-6 weeks after an attack
Epigastric mass
Decreased appetite

Question 13

What will be seen on blood tests with a pancreatic pseudocyst?

Answer 13

Persistent increased amylase and LFTs

Question 14

What is the treatment for a pancreatic pseudocyst?

Answer 14

6cm - either an endoscopic cyst-gastrostomy or a percutaneous drainage with US or CT guidance

Question 15

Give some complications of acute pancreatitis

Answer 15

Early - systemic complications

• Respiratory
• Shock
• Renal failure
• DIC
• Metabolic eg. low Ca2+, high glucose, metabolic acidosis

Late complications - local

• Pancreatic necrosis
• Pancreatic infection
• Pancreatic abscess/ pseudocyst
• Bleeding
• Thrombosis
• Fistula formation