acute pancreatitis

Question 1

define acute pancreatitis?

Answer 1

• An acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems

Question 2

what is the aetiology of acute pancreatitis?

Answer 2

• it is the activation of the pancreatic pro-enzymes in the duct which causes inflammation

Question 3

what are the major causes of acute pancreatitis?

Answer 3

- I GET SMASHED 
Iatrogenic 
gall stones*
ethanol*
trauma 

steroids 
mumps 
autoimmune 
scorpion venom 
hyperlipidemia/calcaemia/thermia 
ERCP 
drugs

Question 4

epidemiology of acute pancreatitis?
main cause in males
main cause in females

Answer 4

common
peak age is 60
- main cause in males is alcohol
- main cause in females is gallstones

Question 5

what are the presenting symptoms of acute pancreatitis?

Answer 5

• severe epigastric pain
• radiating to the back
• relieved by sitting forward
• associated with nausea and vomiting
• often history of gallstones or alcohol

Question 6

what are the signs of acute pancreatitis on examination?

Answer 6

• epigastric tenderness
• fever
• tachcardia/pnoea
• low bowel sounds
• may see turners sign or cullens sign

Question 7

what are the main bloods to look for in acute pancreatitis?

Answer 7

- bloods will show high..
amylase 
white blood cells 
glucose 
CRP 

low calcium

Question 8

what does an ultrasound look for?

Answer 8

• biliary dilatation

- gallstones

Question 9

what does an erect chest xray show?

Answer 9

• may show pleural effusion

- also excludes other causes

Question 10

what might a CT scan show?

Answer 10

• shows signs of sepsis
• shows necrosis
  can use scoring system balthazar score

Question 11

how is acute pancreatitis assessed?

Answer 11

• using the GLASGOW scale
• using the acrynom
  PO2
  A age >55
  N eutrophils >15x10^9
  Ca2+<2mmol/L
  uRea >16
  Enzymes LDH>600
  Albumin >32
  Sugar >10

ransons is used for alcoholic pancreatitis

Question 12

how is acute pancreatitis managed?

Answer 12

• fluids and electrolytes
• Ng tube if vomiting
• analgesia
• blood sugar control
• enterel feeding
• NO antibiotics

Question 13

how are gallstone patients managed ?

Answer 13

• ERCP and sphincterotomy

Question 14

how are patients with necrotising pancreatitis managed?

Answer 14

• necresectomy

- drainage of all necrotic tissue

Question 15

local complications with acute pancreatitis ?

Answer 15

• pancreatic necrosis
• pseudocyst
• abscess
• ascites
• venous thrombosis

Question 16

systemic complications with acute pancreatitis ?

Answer 16

• multiorgan failure
• sepsis
• renal failure
• ARDs
• diabetes
• hypocalcaemia

Question 17

long term complications of acute pancreatitis ?

Answer 17

• chronic pancreatitis

Question 18

prognosis of acute pancreatitis ?

Answer 18

20% is severe with high mortality

80% is mild