Pancreatitis

Question 1

Define acute and chronic pancreatitis

Answer 1

Clinical diagnosis of pancreas inflammation
Difference between chronic and acute is in the self limiting of it
Acute is self limiting and reversing injury
Chronic is with recurrent or persistent insults which leads to scarring and loss of function

Seperated in:
Recurrent acute pancreatitis (cause determined)
Idiopathic pancreatitis
Chronic relapsing pancreatitis-no hallmarks of chronic pancreatitis
established Chronic pancreatitis-hallmarks are present

Question 2

Aetiology and risk factors of acute and chronic pancreatitis

Answer 2

Mechanisms are unclear-seem to be a mix of oxidative damage, toxic metabolic factors, ductal obstruction,.
Possible continuous cycle of cytokine/autoimmune causes the chronic pancreatitis
Acute seems to be more direct insult by causes, like ethanol being direct toxin

aetiologies
Acute: GETSMASHED + idiopathic
Gallstones, Ethanol, trauma, Steroids, Mumps, Autoimmune, scorpion poison, hypercalceamia, ECRP,drugs
chronic-mainly alcohol (80%) and idiopathic

risk factors
Any GETSMASHED
Alcohol
Middle age women-gallstones
Men-alcohol
Sjorgens
FHx

Chronic-alcohol, smoking, coeliac, FHx

Question 3

Epidiemology of acute and chronic pancreatitis

Answer 3

Acute-quite common, esp common cause of epigastric pain
60 in 100 000 in UK
alcoholic more in men
gallstones more in old white women

Chronic-affects lots of people, but about 18 in 100000 per year-prevalence of about 0.03% of population

Question 4

Signs and Sx of acute pancreatitis and chronic

Answer 4

Acute RUQ/Epigastric pain, radiating to back
Sudden onset, constant, severe
Like “stabbed by knife”
worse with move

Nausea and vomiting
Signs of hypovalemia-dry mouth, hypotense
Pleural effusion in 50% of cases (stony dull percuss)
Severe gallstone-jaundice

Chronic:
Dull epigastric pain radiating to back
Diminished by sitting forward
more longer/constant than in acute

Steatorrhoae-whitish, floaty, smelly stool

10% get jaundice

Weight loss, appetite loss
Nausea and vom

hallmarks are pancreas loss of function-high blood glucose, steatorrhea

Question 5

Investigations of acute and chronic pancreatitis

Answer 5

Amylase-
acute-3x the normal
Chronic-normal

CRP-acute high
FBC-can have leukocytosis in acute

High urea in acute

LFT’s-gallstone picture (acute)

CXR-can show pleural effusion

Blood glucose-normal in acute, raised in chronic

CT scan-pancreatic calcification, enlargement, ductal dilatation-chronic
USS can also do

Question 6

Management of acute and chronic pancreatitis

Answer 6

Acute-fluid ressus if needed
Gallstone-ERCP+cholycystetomy
Alcohol-stop alcohol
Pain killers-morphine

Chronic-Sx relief-reduce pain and steatorrhea
pain-paracetamol, but doesn’t work great
Octreotide for pain (somatostatin analogue)
steatorrhea
Give enzyme supplements
surgery for decompression

Question 7

Complications of acute and chronic pancreatitis

Answer 7

Acute :
Other organs failing:
Renal failure (toxins or rhabdomyalsis)
ARDS
Pancreatic abscesses-infection following
abdo compartment syndrome-big killer
Chronic pancreatitis
Sepsis

Chronic-pancreatic cancer-need screening esp in high risk
CVD COMPLICATIOSN
Pancreatic enzyme insufficiency-malnutrition and steatorrhea
Insulin dependent diabetes
pancreatic duct obstruction
Reducion of bone density

Question 8

Prognosis of acute and chronic pancreatitis

Answer 8

Acute-80% improve in 7 days
mortality is about 5%
Long term is based on aetiology, but if lifestyle modification can be fine
progression to chronic pancreatitis is not as fine

Chronic-pain decreases or disappears over time
10y survival in 25%-low–CVD complications main killer