Pancreas

Question 1

Acute pancreatitis

Definition. (1)

Answer 1

Diffuse inflammation of the pancreas

Question 2

Acute pancreatitis

More common in F/M?

Answer 2

Female

Question 3

Acute pancreatitis

IGETSMASHED mnemonic for causes of acute pancreatitis.

List it out. (11)

Answer 3

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/Malignancy
Autoimmunegilyceri
Scorpion sting
Hypertriglycerides or Hypercalcemia

Question 4

Acute Pancreatitis

What is the most common cause of pancreatitis? (3)

Answer 4

Gallstones (40-70%)
Alcohol (40%)
Post- ERCP (5%)

Question 5

Acute Pancreatitis
What level of
Hypertriglyceridemia can precipitate an attack of pancreatitis?

Answer 5

> 11 mmol/L

Question 6

Acute Pancreatitis

What drugs (SAND) can precipitate pancreatitis?

Answer 6

Steroids, Sulphanomides
Azathioprine
NSAIDS
Diuretics- thiazides

Question 7

Acute Pancreatitis

What signs of hemorrhagic pancreatitis can be seen on PE? (2)

Answer 7

Grey Turner sign:
Bruising and discolouration of the left flank (ecchymosis)

• Cullen’s sign: peri-umbilical ecchymosis
  (tracking of blood via falciform ligament)

Question 8

Acute Pancreatitis

Pathophysiology of acute pancreatitis?

Answer 8

• A trigger/ insult causes premature activation of trypsin
• Via pancreatic ductal outflow obstruction or direct injury to pancreatic acinar cells
• Causes autodigestion
• pancreatic parenchyma destruction

Question 9

Acute Pancreatitis

4 main pathophysiology of acute pancreatitis?

Answer 9

1) Blockage of secretion with intra-acinar activation of proteolytic enzymes

2) Microcirculatory injury

3) Activation of immune response

Question 10

Acute Pancreatitis

Two types of acute pancreatitis?

Answer 10

• Acute interstitial oedematous pancreatitis
• Necrotising pancreatitis

Question 11

Acute Pancreatitis

How is acute pancreatitis diagnosed?

Answer 11

Have 2/3 following criteria:

Acute, severe epigastric pain radiating to the back

• Elevation of serum lipase or amylase >3x the upper limit
• Imaging finding characteristics of acute pancreatitis (CECT)

Question 12

Acute Pancreatitis

Elevated ALT >3x the upper limit of normal predicts gallstones as the cause of acute pancreatitis (T/F)

Answer 12

True

Question 13

Acute Pancreatitis

Why serum calcium levels low (<2.0mmol/L) in acute severe pancreatitis?

Answer 13

due to saponification

Question 14

Acute Pancreatitis

Other causes of raised amylase?

Answer 14

• Salivary gland inflammation
• Upper GI perforation
• Mesenteric infarction
• Torsion of intra-abdominal viscus
• Ectopic pregnancy

Question 15

Acute Pancreatitis

Imaging modalities?

Answer 15

• Abdominal US: to exclude gallstones
  pancreatitis: peri-pancreatic fluid build up, indistinct pancreatic margin