Pancreatitis (Acute)

Question 1

def

Answer 1

acute inflammation of the pancreas

1 mild
-minimal organ dysfunction + recovery
2 severe
-organ failure +/ complications (necrosis)

Question 2

aetiology

Answer 2

insult to pancreas causes activation of pancreatic proenzymes resulting in tissue damage + inflammation

Question 3

where does activation of pancreatic proenzymes occur

Answer 3

duct/acini

Question 4

common causes of acute pancreatitis

Answer 4

1 gallstones
2 alcohol
--80% of cases--
3 drugs
4 trauma
5 ERCP/abdominal surgery
6 infection

Question 5

what drugs can cause acute pancreatitis

Answer 5

steroids
azathioprine
thiazides
valproate

Question 6

what infections can cause acute pancreatitis

Answer 6

mumps
EBV
CMV
coxsackie B

Question 7

what is the mnemonic for causes of pancreatitis

Answer 7

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune 
Scorpian venom
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP + emboli
Drugs

Question 8

epi

Answer 8

common
1/1000 PA in UK
60yrs

Question 9

what is the most common cause of pancreatitis in females

Answer 9

gallstones

Question 10

what is the most common cause of pancreatitis in males

Answer 10

alcohol

Question 11

history

Answer 11

1 severe epigastric/abdominal pain
2 nausea + vomiting
3 history of gallstones/excess alcohol

Question 12

what is the pain like in acute pancreatitis

Answer 12

severe epigastric/abdominal pain
radiates to back
relieved by sitting forward
aggravated by movement

Question 13

examination

Answer 13

1 tachycardia
2 jaundice
3 epigastric tenderness + guarding
4 reduced bowel sounds due to ileus

Question 14

what signs of bruising are indicative of pancreatitis

Answer 14

1 grey-turners sign
-flank bruising
2 cullens sign
-periumbilical bruising

Question 15

why do grey-turners sign and cullens sign occur

Answer 15

blood vessel autodigestion from pancreatic enzymes + retroperitoneal haemorrhage

Question 16

investigations

Answer 16

1 bloods
-very high amylase
-high glucose
2 ABG
-for hypoxia + metabolic acidosis
3 USS
-for gallstones
4 erect CXR/ AXR
-exclude other causes (perforation)
-if no psoas shadow indicates increased retroperitoneal fluid

Question 17

what imaging is used to assess the severity and involvement of complications

Answer 17

CT/MRI

Question 18

what level of serum amylase would you expect in acute pancreatitis

Answer 18

> 1000u/ml
or
3 times the upper limit of normal

Question 19

why is amylase raised in acute pancreatitis

Answer 19

when the pancrease becomes inflamed it releases amylase into the blood

Question 20

what does amylase do

Answer 20

breaks down starch

Question 21

what marker is most specific for pancreatitis

Answer 21

lipase

breaks down fat

Question 22

when do amylase levels start to fall

Answer 22

24-48h after onset

therefore amylase may be normal is severe pancreatitis

Question 23

how is pancreatitis severity assessed

Answer 23

1 modified glasgow criteria (within 48h)

2 Ransons criteria (for alcoholic pancreatitis after 48h)

Question 24

what is the modified glasgow criteria

Answer 24

assesses severity of pancreatitis
for gallstones +alcoholic pancreatitis

PaO2 <8kPa
Age >55yrs
Neutrophilia WBC>15x10^8
Calcium <2mmol/l
Renal function urea >16mmol/l
Enzymes LDH>600, AST >200
Albumin <32g/l (serum)
Sugar BG>10mmol/l

Question 25

management

Answer 25

1 medical
-nil by mouth (NG tube)
-IV fluids + electrolytes
-catheterisation
-analgesia (morphine)
-blood sugar control
2 ERCP
-gallstone removal with jaundice
3 surgical
-patients with necrotising pancreatitis undergo necresectomy

Question 26

why is a patient with acute pancreatitis nil by mouth and fed via a NG tube

Answer 26

to reduce pancreatic stimulation

Question 27

complications

Answer 27

1 local
-pancreatic necrosis
-pseudocyst (peripancreatic fluid)
-venous thrombosis which can lead to bowel necrosis
2 systemic
-multiorgan dysfunction
-sepsis
-renal failure
3 long term
-chronic pancreatitis

Question 28

prognosis

Answer 28

20% severe pancreatitis
-infected pancreatic necrosis has 70% mortality
80% mild pancreatitis
-still 5% mortality