Pancreatitis

Question 1

Causes of pancreatitis

Answer 1

-i get smashed
Idiopathic
Gallstones (45 %)
Ethanol (3 5%)
Tumours
Scorpion stings
Microbiology (TB, CMV, HIV, hepatitis, mumps , rubella varicella)
Autoimmune
Surgery
Hyperlipidemia (tg>11.3), hypercalcemia, hypothermia
Emboli or ischemia
Drugs (furosemide, Asa, estrogen, GLP1i; -valproate, H2 blockers, Abx)

Question 2

Signs of acute pancreatitis

Answer 2

• Constant severe epigastiic pain with radiation to the back.
• pain ↓ by leaning forward
• nausea, vomiting
• fever
• jaundice
• tachycardia, hypotension
• cullers I grey turners (if hemorrhagic pancreatitis)

Question 3

Complications of pancreatitis

Answer 3

Local → abscess, neuctizing pancreatitis, pleural effusion, pericardial effusion
Systemic → pneumonia,ARDS,ARF, ATN, pericarditis

Question 4

Ix for acute pancreatitis

Answer 4

↑ WBC
↑ amylase 3x
↑ lipase 3x → preferred test
↑ALT >100
U/s abdomen
Ct scan abdomen
Air - sentinel loop, colon cut off sign
To isolate and treat causes → Ercp, TG

Question 5

Ix to calculate prognosis of acute pancreatitis

Answer 5

LDH,
glucose,
AST,
calcium ,
hCt,
arterial po2
urea

Question 6

Management of acute pancreatitis

Answer 6

Iv fluids → ns or ringers (normalize vitals and urine output
Npo, ng suction, early oral feeding unless necrotizing or severe pancreatitis
Analgesia
Follow clinically and with ct

Abscess → drain only (no abx)
Infected pancreatic necrosis, acute biliary pancreatitis → surgery

Question 7

Ranson’s criteria for prognosis

Answer 7

At admission: glucose > 11, LD H > 350, AST > 250, WBC >16 age >55,
At 48 hrs: ca < 2, decrease in HCT > 10%, aPO2 <60, base > 4, urea increase >1.8

Score vs mortality
<2 → 5%
3-4 → 15- 20%
5 - 6 → 40%
7 or more → 99%