Pancreatitis

Question 1

What is pancreatitis?

Answer 1

Acute inflammatory process in the pancreas

Question 2

Possible cause?

Answer 2

Due to reflux of bile in pancreas or hyperstimulation of pancreatic acinar cells. These activated enzymes autodigest the pancreas

Question 3

3 Possible outcomes of pancreatic enzymes digesting pancreas?

Answer 3

Pseudocyst
Hypoperfusion leading to toxic metabolites in to the peritoneal cavity/blood causing shock
Bacteria infection when there is a hypoperfusion resulting in necrosis or abscess

Question 4

Who gets pancreatitis?

Answer 4

I - Idiopathic 
G- Gallstones
E- Ethanol (alcohol)
T- Trauma 
S- Steroids
M- Mumps (Hep B and coxsackie B)
A- Autoimmune
S- Scorpion bite 
H- Hypercalcaemia/ hyperthyroidism/hyperlipidaemia 
E- ERCP
D- Drugs (azathropin)

Question 5

Presentation of acute pancreatitis?

Answer 5

Acute onset- epigastric pain radiating to back 
Very severe 
Nausea and lots of vomiting 
Jaundice 
Soft abdomen 
Normal bowel sounds 
Fullness of epigastrium

Question 6

Diagnosis of pancreatitis?

Answer 6

IV access, bloods, FBC and coags, U&Es, LFTs, Ca, Glucose, Amylase
ABG- hypoxia, ARDS
US- check for GS
CT

Question 7

Management of pancreatitis?

Answer 7

80% with only analgesia
Fluid resuscitation
Oxygen

Question 8

What can prognosis for pancreatitis be measured with?

Answer 8

Glasgow score

Question 9

What is the Glasgow score?

Answer 9

PaO2<8 kPa 
Age >55 years 
Neutrophils 
Calcium (<2mmol)
Renal function ( >16 mol)
Enzymes (AST/ALT)
Albumin 
Sugar 

3 or more = severe pancreatitis

Question 10

Local complications of pancreatitis?

Answer 10

Fluid collection 
Pseudocysts 
Abscess 
Necrosis 
Ascites 
Pleural effusion