Acute Pancreatitis

Question 1

Acute pancreatitis?

Answer 1

• Is when the pancreas become inflamed (swollen) over a short period of time. Acute pancreatitis is a clinical diagnosis, based mainly on the presenting features and amylase level.

Question 2

Causes ?

Answer 2

• Short list of causes:
- Gallstones
- Alcohol
- Post-ERCP

• Long list of causes
• Mnemonic : I GET SMASHED
- I : Idiopathic

• G : Gallstones
• E : Ethanol (alcohol consumption)
• T : Trauma
• S : Steroids
• M : Mumps
• A : Autoimmune
• S : Scorpion sting
• H : Hyperlipidemia
• E : ERCP
• D : Drugs

Question 3

Clinical presentation?

Answer 3

• Severe epigastric pain
• Radiating to the back
• Abdominal tenderness
• Associated with vomiting
• Systemically unwell

Question 4

Investigations?

Answer 4

• FBC (white blood cells)
• U&E (urea)
• LFT
• Calcium
• ABG
• Amylase ( raised more than 3times, in chronic might not rise cause pancreas has reduced function)
• Lipase ( also raised, it’s more sensitive and specific than Amylase)
• CRP ( to monitor the level of inflammation)
• CT abdomen ( can access for complications of pancreatitis)
• Ultrasound

Question 5

The criteria for the Glasgow score?

Answer 5

• The Glasgow score is used to assess the severity of pancreatitis :
- 0-1 : mild pancreatitis
- 2 : moderate pancreatitis
- 3 or more : severe pancreatitis

• The criteria for the Glasgow score can be remembered using the PANCREAS mnemonic :
P: PaO2 < 8 KPa
A: Age > 55yo
N: Neutrophils (WBC>15)
C: Calcium < 2
R: uRea > 16
E: Enzymes (LDH > 600 or AST/ALT >200)
A: Albumin <32
S: Sugar (glucose >10)

Question 6

Complications?

Answer 6

• Necrosis of pancreas
• Chronic pancreatitis
• Abscess formation

Question 7

Differential diagnosis?

Answer 7

• Peptic ulcer disease
• Cholecystitis (inflammation of the gallbladder)
• Cholangitis ( inflammation of the bile duct system)

Question 8

Management?

Answer 8

• Nil by mouth
• IV fluids
• Analgesia
• Careful monitoring
• Treatment of gallstones in gallstones pancreatitis (cholecystectomy)
• Antibiotics, if there is evidence of a specific infection (abscess of infected necrosis area)
• Treatment of complications