Acute pancreatitis

Question 1

Pathophysiology

Answer 1

Autodigestion of pancreatic tissue by the pancreatic enzymes leaving to necrosis

Question 2

Features

Answer 2

Severe epigastric pain radiating to the back

Associated vomiting

Abdominal tenderness

Systemically unwell

Question 3

Signs

Answer 3

Cullen’s sign (periumbilical discolouration)

Grey Turner’s sign (flank discolouration)

Both rare

Question 4

Investigations

Answer 4

FBC for WCC

U&Es for urea

LFT for transaminases and albumin

Calcium

ABG for PaO2 and blood glucose

Amylase raised x3 in acute

Lipase raised in acute

CRP

Question 5

Imaging

Answer 5

US is initial investigation of choice for assessing gallstones

CT abdomen can assess for complications

Question 6

Glasgow score used for

Answer 6

Assessing severity

0-1 mild

2 moderate

> 3 severe

Question 7

Glasgow score criteria

Answer 7

PaO2 <8

Age >55

Neutrophils (WCC >15)

Calcium <2

Urea >16

Enzymes (LDH >600 or AST/ALT >200)

Albumin <32

Sugar (glucose >10)

Question 8

Key aspects of care

Answer 8

Fluid resuscitation- aggressive crystalloids

Analgesia

Not routinely NBM unless vomiting

Enteral offered if moderate/ severe within 72 hours presentation

Don’t offer antibiotics

Question 9

Role of surgery

Answer 9

Gallstones- early cholecystectomy

Obstructed biliary system due to stones- ERCP

Infected necrosis- radiological drainage of surgical necrosectomy

Question 10

Complications

Answer 10

Necrosis of the pancreas

Infection in necrotic area

Abscess formation

Acute peripancreatic fluid collections

Pseudocysts after 4 weeks

Chronic pancreatitis

Question 11

Most common cause of chronic pancreatitis

Answer 11

Alcohol

Question 12

Key complications of chronic pancreatitis

Answer 12

Chronic epigastric pain

Loss of exocrine function (lack of pancreatic enzymes secreted into GI tract)

Loss of endocrine function (lack of insulin leading to diabetes)

Damage and strictures to the duct system resulting in obstruction

Formation of pseudocysts or abscesses

Question 13

Management of chronic pancreatitis

Answer 13

Abstinence from alcohol and smoking

Analgesia

Creon (otherwise leads to malabsorption of fat, steatorrhoea and deficiency in fat soluble vitamins)

SC insulin

ERCP with stenting

Surgery (chronic pain, onstruction, pseudocysts, abscesses)

Question 14

Pain in chronic pancreatitis

Answer 14

Typically worse 15-30 minutes following a meal