Pancreatitis

Question 1

What is the prominent feature of pancreatic pathology and what are associated features

Answer 1

Back pain

Nausea and vomiting

Question 2

What is the basic problem in acute pancreatitis

Answer 2

Autodigestion of pancreatic tissue by it’s own enzymes

Question 3

What triggers this autodigestion of pancreatic tissue

Answer 3

1. Obstruction to flow of pancreatic juice

2. Direct damage to pancreatic ductal epithelium from ischemia, drugs, toxins, trauma or viral infections

Question 4

Acute pancreatitis with pancreatic necrosis is known as

Answer 4

Hemorrhagic pancreatitis

Question 5

5% of cases of acute pancreatitis are complicated by

Answer 5

Clinically significant pseudocyst

Question 6

What are the common cause of acute pancreatitis

Answer 6

GETSMASHED PNEUMONIC

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion bites
Hyperlipidaemia/hypercalcaemia
ERCP
Drugs : SAND = Steroids and sulphonamides ,azathioprine ,NSAIDs and diuretics

Question 7

Which blood investigations would you require for Acute pancreatitis

Answer 7

1. Serum amylase: diagnostic if elevated >5×
2. FBC
3. Blood glucose
4. ABG
5. Clotting profile
6. Urea and creatinine
7. Electrolytes : calcium etc
8. LFTs

Question 8

In which scenarios would amylase not be increased in acute pancreatitis

Answer 8

1. When the condition has already been present for a few days
2. Where the attack occurs against the background of chronic pancreatitis

Question 9

How does the high risk patient present clinically

Answer 9

1. Dyspnoea / Tachypnoea

2. Shiny face

Question 10

What is the role of radiological investigations in pancreatitis and which ones you would require

Answer 10

-To exclude other acute abdominal conditions like free air under the diaphragm and bowel obstruction

• Abdominal Xrays , supine and erect
• Chest xray
• ultrasound but not reliable
• CT scan : after 10 to 14 days when the inflammation has resolved or earlier on when the diagnosis is inconclusive

Question 11

What are finding on Xrays that would support the diagnosis of acute pancreatitis (4)

Answer 11

• Left sided pleural effusion
• calcifications in the vicinity of the pancreas : indicative of underlying chronic pancreatitis
• Sentinel loop = single , dilated loop in the left upper abdomen
• Colon cut off sign

Question 12

What is required for the diagnosis of Acute Pancreatitis

Answer 12

1. Epigastric pain of acute onset which is severe and persistent ,often radiating to the back
2. Serum lipase/amylase activity of atleast 3× greater than the upper limit of normal
3. Characteristic findings of acute pancreatitis on CET or MRI or trans abdominal ultrasound

Question 13

What alleviates the pain

Answer 13

Sitting up and leaning foward alleviates the pain and they are uncomfortable lying supine

Question 14

Other sources of elevated amylase

Answer 14

• PUD
• Intestinal obstruction
• Perforated bowel
• cholecystitis
• Cholangitis
• Appendicitis
• Pancreatic Cancer
• Renal failure
• ARDS
• DKA