Pancreas: Pancreatitis

Question 1

Causes (mnemonic)

Answer 1

Idiopathic
Gallstones (v common)
Ethanol (most common)
Trauma
Scorpion venom
Mumps/malignancy
Autoimmune
Steroids
Hypertriglycerides, hypercalcemia
ERCP
Drugs - aza, mesalazine, furosemide, valproate

Question 2

Presentation

Investigations

Answer 2

Acute dull constant E abdo pain => back
N+V, diarrhoea

High HR, fever
Ileus
Cullens, Turners

Ix

• DEFINITIVE - v high amylase and lipase
• LFT, US for GS

Question 3

What are the possible differentials for acute pancreatitis

Answer 3

GI

• peptic ulcers => epigastric, no back radiation, reflux, anorexia
• obstruction => surgical history, distension, anorexia, vomiting
• cholangitis => Charcot’s triad (jaundice, RUQ, fever
• choledocholithiasis => RUQ, jaundice
• cholecystitis => pain after fatty meal in RUQ, anorexia, N+V, fever
• hepatitis => jaundice, RUQ, anorexia, tired

CV

• AAA => CV risk factors, tearing abdo pain, hypotension, mottled lower extremities, abdo distension
• MI

Question 4

Management

Answer 4

Immediate - fluids (Hartmann, monitor output with catheter), pain relief, supportive

Definitive - Surgery, ERCP or cholecystectomy if GS
If alcohol related, reduce intake after recoveery

Compllication management

• preop IV ABx, drainage of infected pseudocysts, abscess
• preop IV ABx, debridement of necrosed tissue

Question 5

Complications

Answer 5

Peripancreatic fluid collections => pseudocysts
Pancreatic necrosis
Pancreatic abscess
Haemorrhage

=> AKI from hypovolemia
=> sepsis

Question 6

Factors indicating severe pancreatitis

Answer 6

Age 55+
Low Ca
High glucose
Hypoxic
Neutrophilia
High LDH, AST
Organ dysfunction