Pancreatitis

Question 1

What is the clinical presentation of chronic pancreatitis?

Answer 1

• Epigastric pain ‘bores’ through to the back, eg relieved by sitting forward or hot water bottles on epigastrium/back (look for erythema ab igne’s mottled dusky greyness); triggered by fatty foods
• bloating;
• steatorrhoea;
• weight loss;
• brittle diabetes.

Symptoms relapse and worsen.

Question 2

What are the causes of chronic pancreatitis?

Answer 2

Alcohol; smoking; autoimmune;

Rarely: familial; cystic fibrosis; haemochromatosis; pancreatic duct obstruction (stones/tumour); congenital (pancreas divisum)

Question 3

What are the tests to diagnose chronic pancreatitis?

Answer 3

USS ± CT —> pancreatic calcifications

MRCP

AXR - speckled calcification, faecal elastase

Question 4

How is chronic pancreatitis managed?

Answer 4

Drugs - analgesia, creon, fat-soluble vitamins, Insulin

Diet - no alcohol, low fat

Surgery - for unremitting pain; narcotic abuse (beware of this); decreased weight: eg pancreatectomy or pancreaticojejunostomy (a duct drainage procedure).

Question 5

What is acute pancreatitis?

Answer 5

Sudden inflammation of the pancreas resulting in intense pain. The premature intracellular trypsinogen activation, releasing proteases which digest the pancreas and surrounding tissue (auto-digestion) Triggers for this are many, including alcohol, gallstones and pancreatic duct obstruction.

Question 6

What are the signs and symptoms of acute pancreatitis?

Answer 6

• Sudden intense pain, umbilicus to chest and radiates to back
• N&V
• Fever

Question 7

How is acute pancreatitis diagnosed?

Answer 7

Bloods - Elevated lipase/amylase

CT/MRI - confirm diagnosis

Question 8

How is acute pancreatitis managed?

Answer 8

Surgical removal

Cholecystectomy - if secondary to gall stones

Creon - for insufficiency

Avoid alcohol, smoking, fatty food, medications

Diet control

Question 9

A patient presents with 6-hour history of severe upper abdominal pain with radiation to the back. She reports some nausea and vomiting but denies any diarrhoea or fever. She looks unwell and examination of her abdomen reveals epigastric tenderness. She has a raised WCC and neutrophils. What’s the underlying cause?

Answer 9

Gallstones. She has pancreatitis.

Question 10

A diagnosis of chronic pancreatitis is suspected. Which imaging modalities would be best to confirm this diagnosis?

Answer 10

CT pancreas with IV contrast

Question 11

What do a raised amylase and a cystic lesion following pancreatitis most likely to represent?

Answer 11

Pancreatic pseudocyst

Question 12

How is a Pancreatic pseudocyst managed?

Answer 12

Conservatively