Pancreatitis - Acute

Question 1

Define Acute Pancreatitis

Answer 1

Acute inflammation of the pancreas

Question 2

Aetiology of Acute Pancreatitis

Answer 2

(idiopathic) 
Gallstones
Ethanol
Trauma
Steroids
Mumps, malignancy 
Autoimmune
Scorpion sting
Hypercalcaemia, hypertriglyceridaemia
ERCP 
Drugs e.g. thiazides, azathioprine, furosemide

Question 3

Epidemiology of Acute Pancreatitis

Answer 3

Increasing in incidence
Alcoholic more frequent in men
Gallstone more frequent in white women

Question 4

Symptoms of Acute Pancreatitis

Answer 4

Epigastric pain (relieved, sitting forward, radiates to the back, worse on movement)
Nausea and vomiting
Pleural effusion: SOB, cough, chest pain, tighteness
Anorexia
Dyspnoea
Jaundice

Question 5

Sign of Acute Pancreatitis on examination

Answer 5

Epigastric tenderness
Fever
Shock (tachys)
Reduced bowel sounds
Cullen's
Grey-Turner's

Question 6

Investigations for Acute Pancreatitis

Answer 6

Atlanta Criteria:

1. Sudden, severe persistent epigastric pain radiating to the back
2. Elevated lipase/amylase to 3x greater the upper limit of normal
3. Characteristic findings of acute pancreatitis on imaging e.g. enlarged pancreas, fat stranding

USS: visualise inflammation + look for gallstones

LFTs: Amylase raised
FBC: WCC raised
CRP: raised
U&Es: may be deranged

CXR - check for pleural effusion/ARDS
CT: exclude other conditions
MRCP: look for gallstones

Question 7

Management for Acute Pancreatitis

Answer 7

1. fluid resus
2. analgesia + anti-emetic
3. oxygen if sats low
4. catheter and NG (Ryles) tube if vomiting
5. Nutritional support
6. Thromboprophylaxis

Hypocalcaemia - replacement
Infection - IV Abs
Gallstone - ERCP, sphincterectomy
Alcohol- thiamine, vit B

Question 8

Local complications of Acute Pancreatitis

Answer 8

Pancreatic pseudocyst
Pancreatic abscess
Pancreatic necrosis

Paralytic ileus, duodenal stress ulceration, fistula to colon

Question 9

Systemic complications

Answer 9

Acute renal dailure 
Sepsis 
ARDS 
DIC 
Metabolic Hypocalcaemia
DM 
Shock 
encephalopathy

Question 10

Prognosis of Acute Pancreatitis

Answer 10

Mortality 5%, 35% in severe disease

20% follow severe fulminating course with high mortality

Question 11

What scoring system is used for pancreatitis mortality

Answer 11

Modified Glasgow score (PANCREAS)
PaO2 <8 
Age >55
Neutrophils (WCC>15)
Calcium <2 
uRea >16 
Enzymes LDH >600
Albumin
Sugar >10