acute pancreatitis

Question 1

dx/ definition of acute pancreatitis

Answer 1

According to the atlanta classification. At least two of:
-Characterisitic abdominal pain: cental upper abdo/epigastric pain that is boring and radiates to the back- worse after meals and when supine
- Changes on imaging
- Bichemistry: lipase or amylase elevated 3x UNL

Lipase is more sensitive due to sensitivity, remains elevated longer, more specific to pancreas

Question 2

Types of acute pancreatitis and their definitions

Answer 2

Mild - no local or systemic effects
Moderate- local or systemic effects last <48hours
Severe- systemic effects >48hours

Question 3

Causes of acute pancreatitis

Answer 3

Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps/ malignancy
Autoimmune
Scorpion stings
Hypercalcemia. hyperlipidemia
ERCP
Drugs - azathioprine, valproic acid, liraglutide

Question 4

Management of acute pancreatitis

Answer 4

IVF
Analgesia - IV fentanyl, morphine
Antiemetics
Cease ETOH
If gallstone pancreatitis then cholecystectomy
Early PO intake

Abx only if infected or acute cholangiits- pip/tazo

Question 5

Examinations findings acute pancreatitis

Answer 5

General
Signs of shock: tachycardia, hypotension, oliguria/anuria
Possibly jaundice in patients with biliary pancreatitis
Abdominal examination
Abdominal tenderness, distention, guarding
Ileus with reduced bowel sounds and tympany on percussion
Ascites
Skin changes (rare)
Cullen sign: periumbilical ecchymosis and discoloration (bluish-red)
Grey Turner sign: flank ecchymosis with discoloration
Fox sign: ecchymosis over the inguinal ligament
Pulmonary examination: signs of pleural effusion and/or ARDS may be present

Question 6

Ix for ?acute pancreatitis

Answer 6

Establish diagnosis: LIPASE and/or amylase
Determine severity: FBC, UEC, ABG, LDH, inflammatory markers, serum calcium
Evaluate for cause: LFTS, triglycerides
US abdo

Question 7

What is the first line imaging modality for acute pancreatitis

Answer 7

Ultrasound

CT abdo not needed to establish diagnosis - used to evaluate for necrotic pancreatitis

Question 8

What findings on US for acute pancreatitis

Answer 8

Features of acute pancreatitis (visible in 20% of cases)
Enlarged hypoechoic pancreas (pancreatic edema)
Peripancreatic fluid and/or ascites
Features of biliary pancreatitis
Cholelithiasis and/or gallbladder sludge
Dilated biliary tree
Evidence of complications: pancreatic pseudocysts, walled-off necrosis (typically > 4 weeks from symptom onset)

Question 10

What calcium levels with acute pancreatitis

Answer 10

Hypocalcemia