Acute pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

Acute pancreatitis is an acute inflammatory process of the pancreas

Question 2

What are the causes of acute pancreatitis?

Answer 2

I GET SMASHED

• Idiopathic
• Gallstones
• Ethanol
• Trauma
• Steroids
• Mumps / Malignancy
• Autoimmune
• Scorpion Sting
• Hypertriglycerides /Hypercalcemia
• ERCP
• Drugs (Azathioprine, Mesalazine,
• Steroids, Valproic acid, L-Asparaginase…)

Question 3

What are the clinical features of acute pancreatitis?

Answer 3

• pain - mostly sudden, severe in epigastric region, increasing, bloating, vomiting, lack of peristalsis,
• Bloomberg signs
• Elevated enzymes (amylase or lipase 3xunv- lipase more sensitive and specific (4-8h – 8-14 days)
• Cullen sign - bruise around belly umbilicus
• Grey-turner sign - bruise flanks / back

Question 4

What is Cullen sign?

Answer 4

Bruise around belly umbilicus

Question 5

What is Grey-turner sign?

Answer 5

Bruise flanks / back

Question 6

Acute pancreatitis - Diagnostics:

Answer 6

• Imaging techniques (CT, US)
• Laboratory tests
  ○ Lipase
  ○ Amylase
  ○ Hematocrit

Question 7

What is the treatment of acute pancreatitis?

Answer 7

• Fluid resuscitation
• Pain management
• Parenteral feeding
• Antibiotics (if infected necrosis)
• ERCP

Question 8

Acute pancreatitis - Differentials?

Answer 8

• Acute pancreatitis
• Peptic ulcer disease Cholecystitis/ choledocholithiasis Gastritis
• Abdominal aortic aneurysm
• Mesenteric ischemia
• Alcoholic hepatitis
• Boerhaave syndrome

Question 9

What are the complications of acute pancreatitis?

Answer 9

• Acute peripancreatic fluid collections (APFCs)
  ○ Enzyme rich juice - occurs within 48 hrs (30-50%)
• Pancreatic pseudocysts
• Acute necrotic collections (ANCs)
• Walled-off necrosis (WON)
• Colonic necrosis,
• Splenic/ portal vein thrombosis,
• Gastric outlet dysfunction.
• SIRS- systemic, inflammatory response syndrome
• MODS- Multiple Organ Dysfunction syndrome
• DIC – disseminated intravascular coagulation (PLT<100k/mm3 + fibrinogen < 1g/l + prolonged coagulation times)

Question 10

MODS = ?

Answer 10

Multiple Organ Dysfunction syndrome

Question 11

SIRS = ?*

Answer 11

systemic, inflammatory response syndrome

Question 12

What is the prognosis for acute pancreatitis?

Answer 12

• Amylase level is not a prognostic indicator
• Based on Multi-organ failure assessment (Marshall Score)
  ○ 0-4 pts for each organ system
  ○ Respiratory (PaO2/FIO2)
  ○ Renal (serum creatinine, μmol/l)
  ○ Cardiovascular (systolic blood pressure,
  ○ Responsiveness to fluid resuscitation
  ○ not responsive to fluid resuscitation;
  ○ + pH <7.3; pH + <7.2 (Off inotropic support).

Question 13

Pancreas divisum:

Answer 13

• A congenital malformation caused by failure of the ventral and dorsal pancreatic buds to fuse at 8 weeks.
• Typically asymptomatic but can cause chronic abdominal pain or pancreatitis.