Pancreatitis (acute and chronic)

Question 1

What is acute pancreatitis?

Answer 1

Acute pancreatitis is a self-limiting and reversible pancreatic injury associated with mid-epigastric abdominal pain and elevated serum pancreatic enzymes

Question 2

What is chronic pancreatitis?

Answer 2

Chronic pancreatitis is characterised by recurrent or persistent abdominal pain and progressive injury to the pancreas and surrounding structures, resulting in scarring and loss of function.

Question 3

What are the risk factors for acute pancreatitis?

Answer 3

Middle aged woman
Young to middle aged men
Gallstones
Alcohol
Hypertriglyceridaemia
ERCP
Trauma
SLE
Sjorgen's syndrome

Question 4

What are the risk factors for chronic pancreatitis?

Answer 4

Alcohol
Smoking
FHx
Coeliac disease

Question 5

What is the epidemiology for chronic and acute pancreatitis?

Answer 5

Acute pancreatitis is a potentially lethal disease that is increasing in incidence. Incidence varies from 4.5 to 79.8 per 100,000 per year in different countries.

Benign pancreatic disease, including chronic pancreatitis, affects 5 to 24 million people in the US and in 2004 accounted for 445,000 hospitalisations and 881,000 physician visits

Question 6

What are the signs and symptoms of chronic pancreatitis?

Answer 6

Abdominal pain
steatorrhoea
Jaundice
Weight loss and malnutrition
N and V
Skin nodules, painful joints, low trauma, abdominal distension

Question 7

What investigations would you do for acute pancreatitis?

Answer 7

Serum lipase or amylase (3x upper limit)
AST and ALT (high)
FBC (leukocytosis)
CRP (Necrosis indicator)
Hct (Necrosis indicator)
ABG (hypoxaemia)
AXR/ CXR
Transabdominal US (pancreas inflammation)
Ratio of serum lipase:amylase (>5)

Question 8

What investigations would you do for chronic pancreatitis?

Answer 8

Blood glucose
CT scan
Abdominal US
Abdo X ray

Question 9

How would you manage acute pancreatitis?

Answer 9

> IV fluids
> Analgesia
> Nutritional support
> Supplemental oxygen
> Anti emetic
> Calcium and magnesium replacement therapy
> (Insulin/ cholecystectomy)
> Vitamins
> ERCP
> IV Abx

Question 10

How would you manage chronic pancreatitis?

Answer 10

> Analgesia
> Lifestyle changes- alcohol and cigarette cessation
> Pancreatic enzymes plus PPI
> Octreotide
> Antioxidants
> Decompression
> ESWL
> Distal pancreatectomy

Question 11

What are the complications of acute pancreatitis?

Answer 11

Acute renal failure
Sepsis
Retroperitoneal bleeding
Infected pancreatic necrosis
Acute lung injury/ ARDS

Question 12

What are the complications of chronic pancreatitis?

Answer 12

Pancreatic exocrine insufficiency
Diabetes mellitus
Pancreatic calcifications
Pancreatic duct obstruction
Low trauma fracture
Pancreatic pseudocyst

Question 13

What is the prognosis of acute and chronic pancreatitis?

Answer 13

Chronic:
Generally, pain decreases or disappears over time, regardless of aetiology

Ten-year survival after diagnosis is 20% to 30% lower than the general population

Acute:
The majority of patients with acute pancreatitis will improve within 3 to 7 days of conservative management.

Long-term prognosis is based on the aetiological factor and patient compliance to lifestyle modifications