ACUTE PANCREATITIS

Question 1

Describe the pathophysiology of pancreatitis

Answer 1

Block in flow of enzymes while synthesis is ongoing

Large amounts of trypsin activated → activate more enzymes → autodigestion of pancreas

Question 2

Which pancreatic enzyme test is more specific to the pancreas?

Answer 2

Lipase > amylase

Question 3

Briefly explain the criteria for diagnosing acute pancreatitis

Answer 3

1. Epigastric pain
2. Elevated amylase/lipase greater than three times upper limit of normal
3. Abnormal imaging (CT)

Need at least 2 out of 3

Question 4

Review I get smashed mnemonic

Answer 4

Question 5

What trauma can cause acute pancreatitis in children?

Answer 5

Seatbelts

Question 6

What childhood infection can cause pancreatitis in children? What visible sign on the face can this infection cause?

Answer 6

Mumps

Parotid gland swelling

Question 7

Which class of anti-diabetic drugs can cause pancreatitis?

Answer 7

GLP-1 agonists

exenatide, liraglutide

Question 8

Why can hypercalcaemia cause acute pancreatitis?

Answer 8

Calcium may deposit in pancreatic ducts and activate trypsinogen

Question 9

What is one of the main reasons we treat high triglyceride levels?

Answer 9

Risk of pancreatitis

mechanism unclear, likely to involve chylomicrons

Question 10

Describe how ERCP works

Answer 10

Endoscopy inserted into duodenum and dye injected into biliary tree which is then detected by fluoroscopy

Question 11

How could a peptic ulcer caused pancreatitis?

Answer 11

Rupture of posterior duodenal ulcer

Question 12

What are the three main points in acute pancreatitis treatment?

Answer 12

• Nil by mouth - no food/liquid: rests pancreas
• IV fluids - significant fluid loss due to pancreatic oedema, inflammation leads to diffuse vascular leak. IVF needed for BP + renal perfusion
• Pain control

Question 13

What is SIRS? What are the four signs? What is it when combined with infection?

Answer 13

Systemic inflammatory response syndrome: syndrome of dysregulated inflammation

→ response to infectious or noninfectious insult

• Temperature >38.3 or <36
• Heart rate >90
• Respiratory rate >20
• Raised WBCs

When combined with ?infection → sepsis

Question 14

Describe the Glasgow criteria and what they indicate

Answer 14

Method of assessing pancreatitis severity: mortality increases with higher score

Question 15

If someone with pancreatitis presents with bleeding what condition should you consider? Explain why this is caused

Answer 15

Disseminated intravascular coagulation (DIC)

• Diffuse activation of clotting factors causing consumption coagulopathy whereby clotting factors run out
• This prolongs PT time and causes thrombocytopenia (used up by clots)
• Blood clots lead to vascular occlusion

Question 16

If someone with pancreatitis develops respiratory symptoms what condition should you consider?

Answer 16

ARDS

→ Caused by damage to capillaries endothelium and alveolar epithelium, protein escapes from vascular space and fluid pours into lung interstitium. Looks like pulmonary oedema on x-ray

Question 17

54 yo pt with acute pancreatitis admission several weeks ago shows the following CT imaging. What is the diagnosis? Explain what it is

♦ what is the prognosis?

Answer 17

Pseudocyst

Walled off collection of oedema with no surrounding epithelium

Usually occurs for weeks after acute pancreatitis

♦ Most resolve wo intervention. Feared outcome is rupture causing peritonitis. Can also become infected causing an abscess

Question 18

A pancreatic abscess is commonly caused by which type of bacteria? How will it present after acute pancreatitis?

Answer 18

Intestinal bacteria e.g. E. coli, klebsiella, pseudomonas

Present as fever and failure to improve clinically

Question 19

What can happen if the inflammation around the pancreas progresses is to involve the fat surrounding? What will this reflect in the bloods?

Answer 19

Fat necrosis

Hypocalcaemia and hypermagnesaemia → this happens due to the release of three fatty acid binding with calcium and magnesium (saponification)

This is why low calcium is a poor prognostic indicator ► suggests inflammation is so extensive it involves fat

Question 20

If severe pancreatitis involves DIC, ARDS, sepsis: what is it likely to lead to?

Answer 20

Multiorgan failure