Acute Pancreatitis

Question 1

What is it?

Answer 1

Acute inflammation of the Pancreas by enzyme-mediated autodigestion

Question 2

What is the acronym for the main causes?

Answer 2

G-Gallstones
E-Ethanol
T-Trauma

S-Steroids
M-Mumps
A-Autoimmune
S-Scorpion Venom
H-Hyperlipidaemia, Hypothermia, Hypercalcaemia
E-ERCP/Emboli
D-Drugs e.g Azathioprine

Question 3

What severity scale does pancreatitis use?

Answer 3

Glasgow Severity Scale

PaO2 <8, >55y/o, Neutrophilia, Calcium <2, Urea >16, Albumin <32, Sugar >10

Question 4

Is it common?

Answer 4

Relatively common, usually caused by Gallstones and Alcohol

Question 5

Symptoms (4)

Answer 5

Severe epigastric pain radiating to the back, nausea, vomiting, pain after alcohol

Question 6

Signs (6)

Answer 6

Tachycardia, hypotension, oliguria (state of sepsis), reduced bowel sounds, cullens and grey turners sign

Question 7

Differentials (3)

Answer 7

MI, Reflux, Cholecystitis

Question 8

What bloods would you do?

Answer 8

Serum Amylase, Serum Lipase, CRP, FBC, U&E, LFT, Blood Glucose, Calcium

Question 9

Other Investigations (6)

Answer 9

Urinary Amylase, CXR, Abdominal Ultrasound, CT (assesses pancreatic necrosis), MRI, MRCP

Question 10

First line treatment (2)

Answer 10

Nil by mouth, IV fluid rescucitation

Question 11

Other treatment: (3)

Answer 11

Analgesia, ERCP and Gallstone removal, prophylactic antibiotics to prevent pancreatic necrosis

Question 12

Complications (7)

Answer 12

Shock, Respiratory Distress, Renal Failure, Pancreatic Necrosis, Pancreatic Insufficiency (causing diabetes and malabsorption), Abscess, Pseudocyst