Pancreatitis

Question 1

What is acute pancreatitis

Answer 1

Rapid onset inflammatory process

Question 2

What is chronic pancreatitis

Answer 2

Progressive inflammation and destruction of pancreatic secretory cells

Question 3

Symptoms of acute pancreatitis?

Answer 3

Severe epigastric pain, radiating to back
Allieviated by sitting forward
Nausea, vomiting, anorexia

Question 4

Signs of acute pancreatitis

Answer 4

Raised amylase/ lipase
High HP, temperature, low BP
Abdo distension
Mild jaundice
Bruised umbilicus/ flanks
PATIENT WILL PROBS BE CURLED UP

Question 5

What does ‘GET SMASHED’ stand for?

Answer 5

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion Bites
Hyperlipidaemia, hypercalcaemia
ERCP
Drugs (thiazide diuretics)

Question 6

How is a diagnosis of acute pancreatitis reached?

Answer 6

2/3 of:

• Typical symptoms
• Pancreatic enzymes more than 3* upper limit of normal
• Radiographic evidence

Question 7

What scale is used to determine the severity of pancreatitis?

Answer 7

Glasgow score

Question 8

Using the correct acronym, state the glasgow score

Answer 8

P- p02<8kpa
A- age >55
N- neutrophils >15
C- Calcium <2
R- Renal function >16
E- eNYMES AST>200
A- Albumin <32
S- Sugar >10

Question 9

Describe mild acute pancreatitis

Answer 9

• No organ failure
• No local or systemic complications
• <3 on Glasgow scale

Question 10

Describe moderate pancreatitis

Answer 10

• Transient organ filure

- Local complications

Question 11

Describe severe pancreatitis

Answer 11

• Persistent organ failure >48 hours

- >3 of glascow score

Question 12

Describe the pathophysiology of acute pancreatitis

Answer 12

• Self- perpetuating pancreatic inflammation by enzyme mediated autodigestion
• Oedema and fluid shifts causing hypovolemia- extracellular fluid trapped in the gut

Question 13

What are the signs and symptoms of chronic pancreatitis

Answer 13

Symptoms: pain, nausea and vomiting, malabsorption leading to weight loss and steatorrhoea
Signs: Low BMI, abdo pain

Question 14

What sign in a stool sample would suggest chronic pancreatitis

Answer 14

Low elastase

Question 15

What is cullens sign

Answer 15

Periumilical bruising

Question 16

What is grey-turners sign

Answer 16

Flank bruising

Question 17

What signs on an abdominal x-ray would suggest pancreatitis

Answer 17

No psoas shadowing

Question 18

What does an Ct show

Answer 18

Pancreatic necrosis

Question 19

Why may an USS be ordered in pancreatitis

Answer 19

To see any gallstones

Question 20

Name the acute complications of pancreatitis

Answer 20

• Intrabdominal haemorrhage
• Pancreatic necrosis
• Biliary obstruction
• Multi organ failure

Question 21

What is a sign of pancreatic necrosis

Answer 21

Peritonitis

Question 22

What are the late complications of pancreatitis

Answer 22

• Pancreatic pseudocyst
• Pancreatic pseudoaneurysm
• Abscess
• Ascites

Question 23

What information is provided by the Ranson and Glasgow scores?

Answer 23

Prognosis

Question 24

What information is provided by the Atlanta criteria

Answer 24

Severity

Question 25

In what 3 cases would you treat pancreatitis with antibiotics?

Answer 25

• Other signs of infection
• Pseudocyst turned abscess
• Necrotising pancreatitis

Question 26

What are the steps in treating/ managing pancreatitis

Answer 26

• NBM
• Analgesia
• Fluid rescusitation

Question 27

What treatment is there for abscess of pancreatic necrosis

Answer 27

• Laparatomy
• Paraenteral nutrition
• Debridgement
• Abx

Question 28

When would ERCP be suggested in pancreatitis

Answer 28

If there is progressive jaundice

Question 29

How would you treat chronic pancreatitis

Answer 29

Enzymes