Pancreatitis

Question 1

When should you consider admission to ICU in a patient with Acute Pancreatitis?

Answer 1

Glasgow Score above 2

Question 2

What are 3 scoring systems to help determine severity of Pancreatitis?

Answer 2

Glasgow Score, Ransom Score, APACHE II

Question 3

What are some causes of Acute Pancreatitis?

Answer 3

I GET SMASHED: Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune / Ascaris Infection, Scorpion sting, Hypertriglyceridaemia / Hypercalcaemia / Hypothermia, ERCP, Drugs: Sodium Valproate, Bendroflumethiazide, Furosemide, Azathioprine, Mesalazine

Drugs mnemonic: Sophias Big Fat American Mum

Question 4

What are the features of Acute Pancreatitis?

Answer 4

Epigastric pain, may radiate to back. Nausea, vomiting, low grade fever, Grey-Turner’s, Cullen’s, ischaemic retinopathy (rare)

Question 5

What is Grey Turner’s sign?

Answer 5

Bruising of flanks caused by pancreatitis

Question 6

What is Cullen’s sign?

Answer 6

Bruising around umbillicus caused by pancreatitis

Question 7

What are some investigations to help diagnose acute Pancreatitis?

Answer 7

Serum amylase, serum lipase, U&Es, LFTs, abdominal US, CT abdomen

Question 8

What is defined as mild, moderate and severe Acute Pancreatitis?

Answer 8

Glasgow score
< 2 = Mild
2 = Moderate
> 2 = Severe

Question 9

What are some complications of Acute Pancreatitis?

Answer 9

ARDS, Pancreatic necrosis, Chronic pancreatitis, Pancreatic pseudocysts, Pancreatic abscess

Question 10

What are the general principles of management in patients with acute pancreatitis?

Answer 10

Escalate care according to Glasgow Score, fluid resuscitation with IV crystalloids

Analgesia with IV opioids

IV antibiotics if infective

Enteral nutrition if vomiting / severe pancreatitis

Endoscopic drainage of cysts
Surgery to remove necrotic tissue

Question 11

CHRONIC PANCREATITIS

1. What is the most common cause in 80% of cases?
2. What are the 3 main features?
3. What are some investigations?
4. What is the management?

Answer 11

1. Alcohol
2. Pain, worsened 15-30 mins after eating a meal, steatorrhoea, diabetes mellitus symptoms
3. Bedside: Blood glucose, Faecal elastase low if pancreatic exocrine insufficiency
   Bloods: lipase and amylase NORMAL
   Imaging: AXR, CT - pancreatic calcification
4. Alcohol abstinence, healthy diet
   Pancreatic enzymes e.g. Creon, pain relief, insulin therapy, coeliac plexus block, pancreatectomy