Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Inflammation of the pancreatic parenchyma, with biochemical associations of increased amylase and raised lipase enzymes on blood test.

Question 2

What are the signs and symptoms of acute pancreatitis?

Answer 2

Epigastric Pain that radiates to the back.
Anorexia.
Nausea and vomiting.
Grey Turner's sign: flank bruising.
Cullen's sign: periumbilical bruising.
'PAN'

Question 3

What are the causes of acute pancreatitis?

Answer 3

Gallstones
Ethanol
Trauma
Scorpion sting (Tityus trinitatis)
Mumps
Autoimmune disease
Steroids
Hyperlipidaemia/ hypercalcaemia
ERCP
Drugs, e.g. azathioprine
'GET SMASHED'

Question 4

What investigations are performed for acute pancreatitis?

Answer 4

Raised serum amylase and lipase.
Detect cause, e.g. ultrasound scan to detect gallstones.
CT scan to rule out complications (not within <72h of acute presentation unless clinically indicated).

Question 5

What is the treatment of acute pancreatitis?

Answer 5

Usually symptomatic relief.
Keep nil by mouth, IV fluids and analgesia, e.g. tramadol.
Treat underlying causes, e.g. ERCP to remove gallstones.

Question 6

What are the complications of acute pancreatitis?

Answer 6

Haemorrhage.
Disseminated intravascular coagulation (DIC).
Acute respiratory distress syndrome (ARDS).
Multiorgan failure.
Necrosis.
‘HDAMN’

Question 7

What is chronic pancreatitis?

Answer 7

The structural integrity of the pancreas is permanently altered as a direct result of chronic inflammation.

Question 8

What are the signs and symptoms of chronic pancreatitis?

Answer 8

Pain! The pain is:

• epigastric in origin
• recurrent
• radiates to the back
• relieved by sitting forward
• worse when eating/drinking heavily

Question 9

What are the causes of chronic pancreatitis?

Answer 9

Cystic fibrosis
Alcohol
Malnourishment
Pancreatic duct obstruction
'CAMP'

Question 10

What investigations are performed for chronic pancreatitis?

Answer 10

Decreased faecal elastase.
CT scan: shows calcification (may also be seen on abdominal x-ray).
MRCP.

Question 11

What is the treatment of chronic pancreatitis?

Answer 11

Conservative: alcohol cessation.
Medical: analgesia, e.g. tramadol and pancreatic enzyme replacement therapy; start insulin therapy if diabetes has developed.

Question 12

What are the complications of chronic pancreatitis?

Answer 12

Pseudocysts
Obstruction (pancreatic)
Diabetes mellitus
Steatorrhoea
'PODS'