Pancreatitis

Question 1

Pancreatitis Aetiology

Answer 1

idiopathic, gallstones, ethanol, trauma, steroids, mumps/malignancy, autoimmune, scorpion stings, hypertriglycerides/hypercalcaemia, ERCP, drugs

Question 2

Pancreatitis S/S

Answer 2

Symptoms
-Pancreatitis pain
Signs
-Tachycardia, dehydration
-Jaundice with common bile duct stones
-Hypoxaemia is characteristic of acute pancreatitis

Question 3

Pancreatitis Ix

Answer 3

• Raised lipase
• Raised bilirubin suggests gallstones
• CT when not clear

Question 4

Pancreatitis Differentials

Answer 4

Causes of raised amylase
-Renal failure, ectopic pregnancy, DKA, perforated duodenal ulcer, mesenteric ischaemia/infarction
Other causes of similar pain
-Small bowel perforation/obstruction, aortic aneurysm, atypical MI

Question 5

Pancreatitis Severity Grading

Answer 5

Apache II score

Question 6

Pancreatitis Management (Mild)

Answer 6

• On a general ward
• Pain relief with buprenorphine ± IV benzodiazepines
• Morphine is contra-indicated because of possible spastic effect on sphincter of Oddi
• IV fluids nil by mouth
• No other treatment

Question 7

Pancreatitis Management (Severe)

Answer 7

• ITU or HDU
• If evidence of necrosis; IV antibiotics
• Enteral nutrition
• Surgery if infection and necrosis

Question 8

Pancreatitis Complications

Answer 8

• Necrosis (riding CRP, confirmed by CT)
• Infected necrosis
• Acute fluid collections
• Abscess and pseudocyst (both require surgery)

Question 9

Pancreatitis Prognosis

Answer 9

-80% of patients have mild disease and recover without complications