Pancreatitis

Question 1

Causes of acute pancreatitis (G.E.T. S.M.A.S.H.E.D.)

Answer 1

• Gallstones
• Ethanol
• Trauma
• Steroids
• Mumps
• Autoimmune
• Scorpion venom
• Hyperlipidaemia, Hypothermia, Hypercalcaemia
• ERCP + Emboli
• Drugs

Also pregnancy + cancers

Question 2

2 most common causes of pancreatitis

Answer 2

• Gallstones

- Ethanol

Question 3

Symptoms of acute pancreatitis

Answer 3

-Gradual or sudden severe epigastric pain
or
-Central abdo pain (radiates to back, may get relief sitting forward)
-Vomiting prominent

Question 4

Signs of acute pancreatitis

Answer 4

• Periumbilical or flank bruising (autodigestion of blood vessels)
• Rigid abdomen
• Ileus
• Tachycardia
• Shock
• Jaundice
• Fever

Question 5

What is Cullen’s and Grey Turner’s sign

Answer 5

• Cullen’s = Periumbilical bruising

- Grey Turner’s bruising

Question 6

Investigation for acute pancreatitis

Answer 6

• Serum amylase (raised)
• Serum lipase (more specific + sensitive to pancreatitis)
• ABG (oxygenation + acid base balance)
• USS (gallstones)
• Abdo CT

Question 7

Management of acute pancreatitis

Answer 7

• Nil by mouth
• IVI nutrition + saline
• Analgesia, morphine/pethidine
• Hourly pulse, BP, FBC, U&E, ABG, amylase

Question 8

Complications of acute pancreatitis (S.A.R.D.S.)

Answer 8

• Shock
• Acute Respiratory Distress Syndrome (ARDS)
• Renal failure
• DIC
• Sepsis

Question 9

Symptoms of chronic pancreatitis (W.E.B.B.S.)

Answer 9

• Weight loss
• Epigastric pain bores through to back (relieved by sitting forward or hot water bottles on back + epigastrium)
• Bloating
• Brittle diabetes (type 1 variant that’s difficult to control)
• Steatorrhoea

Question 10

Causes of chronic pancreatitis

Answer 10

-ALCOHOL

Rarely

• Familial
• CF
• Haemochromatosis
• Pancreatic duct obstruction

Question 11

Investigations for chronic pancreatitis

Answer 11

• USS + CT (?abdo?)
• AXR
• Breath tests (superscript13 C Hiolien)

Question 12

Rx for chronic pancreatitis

Answer 12

• Fat soluble vitamins
• Lipase
• Analgesia (coeliac plexus block)
• Pancreatectomy or pancreaticojejunostomy
• No alcohol
• Low fat diet (might help)

Question 13

Complications of chronic pancreatitis

Answer 13

• Diabetes
• Pseudocyst
• Biliary obstruction
• Local arterial aneurysms
• Pancreatic carcinoma
• Splenic vein thrombosis
• Gastric varices