Pancreatitis

Question 1

what are the criteria for prognosis of acute pancreatitis?

Answer 1

Glasgow critaria

Question 2

Glasgow critaria for the prognosis of acute pancreatitis

Answer 2

age >55 years
pO2 < 8 kpa
WBC count= >15000
Albumin <3.2 g/dl
Serum Calcium <2 mmol/l
glucose> 10mmol/l
Urea >16 mmol/l
Alanine aminotransferase >200U/L
Lactate dehydrogenase >600 U/L

Question 3

Features that predicts severe pancreatitis
initial assessment

Answer 3

clinical impression of severity
BMI >30
pleural effusion on chest xray
APACHE II score >8

Question 4

Features that predicts severe pancreatitis
24 hour assesment

Answer 4

clinical impression of severity
APACHE II score > 8
Glasgow score > 3
persistant organ failure, esp if multiple
CRP > 150

Question 5

Features that predicts severe pancreatitis
48 hours assessment

Answer 5

clinical impression of severity
glasgow score > 3
CRP > 150
persistant organ failure for 48 hours
multiple or progressive organ failure

Question 6

pathogenesis of pancreatitis

Answer 6

premature intracellular trypsinogen activation releasing protease which digest pancreas

Question 7

anti-proteolytic factors name?

Answer 7

intracellular pancreatic trypsin inhibitor protein and circulating beta2 macroglobulin, alpha1 antirypsin and C1 esterase inhibitors

Question 8

complications of acute pancreatitis?
Systemic

Answer 8

systemic inflammatory response syndrome
hypoxia
hyperglycaemia
Hypocalcaemia
reduced serum albumin

Question 9

clinical features of acute pancreatitis

Answer 9

severe constant upper abdominal pain
increasing intensity over 15-60 mins, radiates to back.
Nausea
vomitting
marked epigastric tenderness
no guarding or rebound tenderness
bowel sound: quiet or absent
Discolouration of flanks= grey turner sign
discolouration of periumbilical region= Cullen’s sign

Question 10

what are the signs suggesting severe pancreatitis with haemorrhage??

Answer 10

Grey turner sign
Cullen sign

Question 11

Grey turner sign

Answer 11

discolouration of flanks

Question 12

Cullen’s sign

Answer 12

discolouration of the periumbilical region

Question 13

Causes of Acute pancreatitis?
Common

Answer 13

gall stones
alchohol
idiopathic causes
post ERCP

Question 14

causes of acute pancreatitis?
Rare

Answer 14

post surgical
trauma
drugs (Azathioprine, mercaptopurine, thiazide diuretics, sodium valproate)
metabolic (hypercalcemia, hypertryglyceridemia)
pancreas divisum
Sphincter of Oddi dysfunction
infection (mumps, coxsackie)
hereditary factors
renal failure
organ transplantation
severe hypothermia
petrochemical exposure
scorpion sting

Question 15

Drugs cause of acute pancreatitis?

Answer 15

azathioprine, mercaptopurine, thiazide diuretics, sodium valproate

Question 16

complications of acute pancreatitis?
pancreatic

Answer 16

necrosis
abscess
pseudocyst
pancreatic ascites or pleural effusion

Question 17

complications of acute pancreatitis?
gastrointestinal

Answer 17

upper gi bleeding
variceal hge
erosion into colon
duodenal obstruction
obstructive jaundice

Question 18

confirmatory test for acute pancreatitis

Answer 18

USG

Question 19

which have more diagnostic accuracy in diagnosis of acute pancreatitis

Answer 19

S. lipase

Question 20

S. Amylase are elevated in

Answer 20

intestinal ischemia
perforated peptic ulcer
ruptured ovarian cyst

Question 21

which test is useful indicators for progression and severity of disease?
at what level can we call severe acute pancreatitis?

Answer 21

CRP
CRP >210 mg/dl in the 1st 4 days

Question 22

✳️Choice of painkiller in acute pancreatitis pain?

Answer 22

Opiate analgesics

Question 23

Mx of acute pancreatitis?

Answer 23

painkiller
hypovolemia correction by normal saline or crystalloids
shock correction by fluid, oxygen, catheter
hyperglycaemia by insulin
hypocalcemia by calcium
paralytic ileus by nasogastric aspiration
thromboembolism by LMWH
Antibiotics like carbapenams, quinolones and metronidazole

Question 24

✳️treatment for pancreatic pseudocyst?

Answer 24

treated by draining into the stomach and duodenum
which is done after a 6 weeks interval by surgical or endoscopic cystogastrostomy

Question 25

causes of chronic pancreatitis? Toxic-metabolite

Answer 25

toxic-metabolic ✳️Alchohol tobacco hypercalcaemia CKD

Question 26

causes of chronic pancreatitis? idiopathic, genetic, autoimmune

Answer 26

tropical, early or late onset type hereditary pancreatitis, SPINK1 mutations, cystic fibrosis as a part of multi organ problem

Question 27

causes of chronic pancreatitis? recurrent obstructive

Answer 27

recurrent acute pancreatitis ductal adenocarcinoma, pancreas divisum, intraductal papillary mucinous neoplasia, sphincter of oddi stenosis.

Question 28

⭐️Complications of chronic pancreatitis?

Answer 28

pseudocyst pancreatic ascites obstructive jaundice duodenal stenosis portal or splenic vein thrombosis peptic ulcer secondary DM Pancreatic cancer pancreatic exocrine insufficiency osteopenia or osteoporosis

Question 29

Investigation of chronic pancreatitis? confirmatory

Answer 29

USG CT Abdominal X-ray MRCP Endoscopic US

Question 30

Investigation of Chronic pancreatitis? define pancreatic function test to demonstrate anatomy prior surgery

Answer 30

Secretin stimulation test: gold standard but invasive but seldom used faecal pancreatic elastase MRCP

Question 31

Rx for chronic pancreatitis?

Answer 31

no alchohol pain relief: analgesics or coeliac plexus neurolysis or total pancreatectomy malabsorption: fat restriction and oral pancreatic enzymes supplementation, PPI rx of complications: Surgical approach

Question 32

✳️how to achieve long term pain relief in chronic pancreatitis?

Answer 32

coeliac plexus neurolysis

Question 33

✳️Universal sign of cystic fibrosis?

Answer 33

steatorrhoa