Pancreatitis

Question 1

What is pancreatitis?

Answer 1

Inflammation of the pancreas

Question 2

What are the 2 forms of pancreatitis?

Answer 2

Acute and Chronic

Question 3

What is acute pancreatitis?

Answer 3

Rapid onset of inflammation and symptoms

Question 4

What is chronic pancreatitis?

Answer 4

Long term inflammation and symptoms

Question 5

What is the outcome of acute pancreatitis?

Answer 5

Eventually resolves

Question 6

What is the outcome of chronic pancreatitis?

Answer 6

Progressive and permanent

Question 7

What are the 3 main causes of pancreatitis?

Answer 7

Gall stones
Alcohol
Post-ERCP

Question 8

Who do gallstones tend to occur in?

Answer 8

Women and older people

Question 9

Who tends to develop alcohol induced pancreatitis?

Answer 9

Men and younger people

Question 10

What is the pneumonic for the other causes of pancreatitis?

Answer 10

I GET SMASHED

Question 11

What does I GET SMASHED stand for?

Answer 11

I- Idiopathic
G- Gallstones
E- Ethanol
T- Trauma
S- Steroids
M- Mumps
A- Autoimmune
S-Scorpion sting
H- Hyperlipidaemia
E- ERCP
D- Drugs

Question 12

How does pancreatitis present?

Answer 12

Severe epigastric pain- radiates to back
Vomiting
Abdominal tenderness
Systemically unwell

Question 13

Which drugs can cause pancreatitis?

Answer 13

Thiazide
Furosemide
Diuretics

Question 14

How can the pain be relieved in someone with pancreatitis?

Answer 14

By leaning forward or lying in fetal position

Question 15

What is the main diagnosis for Pancreatitis?

Answer 15

Lipase- more specific than amylase

Question 16

What other investigations are carried out for pancreatitis?

Answer 16

Amylase
C-reactive protein
Ultrasound
CT abdomen

Question 17

What will the level of amylase be in someone with Pancreatitis?

Answer 17

Three times the normal level

Question 18

What does c-reactive protein suggest?

Answer 18

Inflammation

Question 19

What would you see with an ultrasound in someone with pancreatitis?

Answer 19

Gallstones

Question 20

Why would you do a CT abdomen in someone with pancreatitis?

Answer 20

To look for complications

Question 21

How is the severity of Pancreatitis assessed?

Answer 21

Glasgow score

Question 22

What is the pneumonic for the Glasgow score?

Answer 22

PANCREAS

Question 23

What does PANCREAS stand for?

Answer 23

P- Pa02 <60mmHg
A- Age >55
N- Neutrophilia (WBC)>15
C- Calcium <2mmol/L
R- Renal function-Urea >16mmol/L
E- Enzymes- LDH >600iU/L   AST>2000iU/L
A- Albumin <32g/L
S- Sugar- Glucose >10mmol/L

Question 24

What is the management of Acute Pancreatitis?

Answer 24

Initial resuscitation
IV fluids
Analgesia
If gallstones- ERCP or Cholecystectomy

Question 25

What are possible complications of Acute Pancreatitis?

Answer 25

Necrosis of the pancreas Infection in a necrotic area Abscess formation Pseudocysts

Question 26

When do pseudocysts tend to form after pancreatitis?

Answer 26

4 weeks after

Question 27

What does chronic pancreatitis result in?

Answer 27

Fibrosis and reduced function of the pancreatic tissue

Question 28

What is the commonest cause of chronic pancreatitis?

Answer 28

Alcohol

Question 29

How long do the symptoms in chronic pancreatitis last?

Answer 29

Longer than in acute pancreatitis

Question 30

What are the main complications of chronic pancreatitis?

Answer 30

Chronic epigastric pain Exocrine function affected Endocrine function affected Damage and strictures in the duct system

Question 31

How is the endocrine function affected in chronic pancreatitis?

Answer 31

Lack of insulin leading to diabetes

Question 32

How is the exocrine function affected in chronic pancreatitis?

Answer 32

Lack of pancreatic enzymes into GI tract

Question 33

What does damage and strictures lead to due to chronic pancreatitis?

Answer 33

Obstruction

Question 34

What is the lifestyle management of chronic pancreatitis?

Answer 34

Abstinence from alcohol and smoking

Question 35

What is the medical management of chronic pancreatitis?

Answer 35

Pain- Analgesia Replacement of pancreatic enzymes Diabetes- Subcutaneous insulin Obstruction- ERCP with stenting

Question 36

What in the history might indicate acute pancreatitis?

Answer 36

Recent alcohol binge or gallstones

Question 37

What can be seen on examination that is highly indicative of pancreatitis?

Answer 37

Cullen's sign

Question 38

What is cullen's sign?

Answer 38

Bruising around the peri-umbilical area which again is highly associated with pancreatitis.

Question 39

When is the Glasgow score calculated in someone presenting with pancreaitis?

Answer 39

On admission and after 48 hours of admission

Question 40

What would a Glasgow score of more than 3 suggest?

Answer 40

A score of 3 or more positive factors indicates transfer to ITU/HDU for intensive monitoring and aggressive fluid resuscitation

Question 41

What needs to be monitored annually in someone with chronic pancreatitis?

Answer 41

HbA1c