Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Acute or chronic

Pancreatic enzymes (amylase / lipase) attack the pancreatic tissue

Oedematous (70%)
Severe/necrotizing (25%)
Haemorrhage(5%)

Question 2

What are some causes of acute pancreatitis?

Answer 2

“I GET SMASHED”:
I = Idiopathic, G = Gall stones, E = Ethanol, T = Trauma, S = Steroids, M = Mumps, A = Autoimmune, S = Scorpion poison, H = Hypercalcemia, Hypertriglyceridemia, E = ERCP, D = Drugs

Question 3

What are some complications that can arise?

Answer 3

Pancreatitic necrosis
Infection in necrotic areas
Pseudocysts
Chronic pancreatitis

Question 4

What are the clinical features?

Answer 4

• Abdo pain localised to epigastrium
• Radiating to the back
• Nausea and vomiting
• Acutely unwell
• shock
• Cullens sign (periumblical ecchymosis)
• Grey Turner’s sign (left flank ecchymosis)

Question 5

How do we manage patient on presentation?

Answer 5

A to E

Assess severity of attack using Glasgow Imrie criteria

Question 6

How do we establish a diagnosis?

Answer 6

• Serum amylase >1000U
• Serum lipase
• AXR (non-specific findings)
• CT (shows pancreatic oedema, loss of fat planes, may show haemorrhagic or necrotic complications)
• USS- must be within 48h of admission to identify gallstones in bile duct

Question 7

If USS shows bile duct stones, how do we manage?

Answer 7

Urgent ERCP and stone extraction

Question 8

How do we further manage patient?

Answer 8

1. Identify/prevent complications

• IV Abx (eg IV imipenem tds) even if no evid of necrosis
• CT-guided pancreatic aspiration to identify infected necrosis
• Early low volume enteral feeding to reduce risk of stress ulceration and bacterial translocation causing sepsis

Question 9

How do you treat early complications?

Answer 9

• ITU/HDU for optimised fluid balance
• Proven infected necrosis. Surgical debridement…poor prog
• Acute pseudocysts- drain if large

Question 10

First line diagnostic investigation for chronic pancreatitis

Answer 10

CT