Pancreatitis

Question 1

Where is the pancreas located?

Answer 1

Behind the stomach, next to the small intestine

Question 2

What is the endocrine function of the pancreas?

Answer 2

• Insulin
• Glucagon
• Somatostatin
• Pancreatic polypeptide

Question 3

What is the exocrine function of the pancreas?

Answer 3

• Amylase
• Proteases
• Lipases

Question 4

What are the symptomatic consequences of an unwell pancreas?

Answer 4

• Diarrhoea
• Bloating
• Flatulence
• Oily and foul smelling stools
• Weight loss
• Malnutrition
• Poor blood sugar control
• Diabetes

Question 5

What is acute pancreatitis?

Answer 5

Sudden inflammation of the pancreas

Question 6

What are the causes of acute pancreatitis?

Answer 6

GET SMASHED

G - Gallstones
E - Ethanol
T - Trauma

S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion venom
H - Hypertriglyceridaemia, Hyperchylomicronaemia
E - ERCP
D - Drugs 
      (azathioprine, mesealazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

Genetic - Cystic fibrosis and hereditary pancreatitis

Question 7

What are the symptoms of pancreatitis?

Answer 7

• Sudden attacks
• Epigastric pain
• Radiates to the back
• Pain relieved by sitting forward / hot water bottles
• Nausea and vomiting
• Fever
• Tachycardia

Question 8

What blood tests would you order and what would they show?

Answer 8

Amylase and lipase

- Elevated

Question 9

What investigations would you order and what would they show?

Answer 9

- CT/MRI
      Swollen pancreas
      Abnormal fluid around pancreas
- ERCP
      If duct blockage suspected

Question 10

What is the treatment for acute pancreatitis?

Answer 10

• Nil by mouth
• Fluid resuscitation
  Crystalloid
  Monitor urine ouptu
• Analgesia
• Supplemental O2
• Consider antiemetic
• Surgery if gallstones are the cause

Question 11

What is the advice you would give to a patient with acute pancreatitis?

Answer 11

Avoid:

• Alcohol and tobacco
• High-fat foods
• Triglycerides
• Specific medication

Question 12

How can you identify severe pancreatitis?

Answer 12

PANCREAS

P - PaO2 - <8kPa
A - Age - >55yrs
N - Neutrophillia – WBC >15 x 109/L
C - Calcium - <2mmol/L
R - Renal function- Urea >16 mmol/L
E - Enzymes – LDH>600iu/L; AST>200iu/L
A - Albumin - <32g/L (serum)
S - Sugar – Blood glucose >10mmol/L

Question 13

What is chronic pancreatitis?

Answer 13

Long-term inflammation of the pancreas which leads to irreversible damage of the pancreas

Question 14

What are the symptoms of late chronic pancreatitis?

Answer 14

• Oily, foul smelling stools
• Weight loss
• Diabetes
• Recurring pain

Question 15

What diagnostic test would you order for chronic pancreatitis?

Answer 15

• Blood glucose
• Abdo XR
  Calcification
• US +/- CT
  Calcification
• Endoscopic ultrasound
• Faecal elastase
  Decreased

Question 16

What is the treatment for chronic pancreatitis?

Answer 16

• No alcohol
• Smoking cessation
• Avoid high-fat foods
• Analgesia
• PERT (pancreatic enzyme replacement therapy)
• PPI
  Omeprazole
• Multivitamins and mineral supplements

Question 17

What are the complications of chronic pancreatitis?

Answer 17

Type 3c diabetes

- Destruction of islet cells

Question 18

What may you find on examination of a patient with acute pancreatitis?

Answer 18

• Tenderness, ileus and low-grade fever
• Cullen’s sign
  Periumbilical discolouration
• Grey-Turner’s sign
  Flank discolouration

Question 19

What are the complications of acute pancreatitis?

Answer 19

• Peripancreatic fluid collections
• Pseudocysts
• Pancreatic necrosis
• Pancreatic abscess
• Haemorrhage