Pancreatitis (Acute)

Question 1

Define acute pancretaitis

Answer 1

An acute inflammation of the pancreas.

Characterised by:
• Self-perpetuating inflammation due to enzyme-mediated autodigestion.
• Oedema and fluid shifts causing hypovolaemia, as extracellular fluid is trapped in the gut, peritoneum, and retroperitoneum (worsened by vomiting).

Question 2

What are the causes/risk factors of acute pancreatitis?

Answer 2

Causes: I GET SMASHED
• Idiopathic
• Gallstones (in CBD)
• Ethanol
• Trauma
• Steroids
• Mumps, EBV, Mycoplasma, Malignancy
• Autoimmune
• Scorpion bites
• Hypercalcaemia/hypertriglyceridaemia
• ERCP, iatrogenic
• Drugs e.g. azathioprine, mercaptopurine, thiazides, valproate

Risk factors
• Gallstones
• Alcohol

Question 3

What are the symptoms of acute pancreatitis?

Answer 3

• Epigastric pain radiating to the back, relieved by sitting forward, worse on movement
• Nausea & vomiting
• Anorexia

Question 4

What are the signs of acute acute pancreatitis?

Answer 4

• Epigastric tenderness, guarding and rigidity
• Cullen’s/Grey-Turner’s/Fox’s sign
• Tachycardia
• Fever

Question 5

What investigations are carried out for

Answer 5

Bloods
• Raised amylase, glucose and CRP
• FBC
- High WCC
• Low Ca2+
• Deranged LFTs
• ABG
- Hypoxia
- Metabolic acidosis

USS
• Gallstones
• Biliary dilation

Erect CXR
• Pleural effusion

AXR
• Exclude other causes of acute abdomen

CT
• Shows enlargement of the pancreas with irregular contours, necrosis, pseudocysts
and peripancreatic fat obliteration

Question 6

What is the management for acute pancreatitis?

Answer 6

Severity
• APACHE-II score
• Modified Glasgow criteria

Medical
• Drip and suck: IV fluids, Ryles tube
• NBM
• Analgesia
• Blood sugar control

Surgical
• ERCP with sphincterotomy
• Cholecystectomy
• Necrosectomy

Question 7

What are the complications of acute pancreatitis?

Answer 7

• Sepsis and shock - ARDS, AKI, DIC, MOF
• Hypocalcaemia
• Diabetes (hyperglycaemia)
• Pancreatic necrosis and pseudocyst (peri-pancreatic fluid collection, > 4 wks).
• Abscess
• Bleeding due to elastase eroding adjacent arteries.
• Thrombosis in splanchnic vessels.
• Pseudoaneurysms
• Chronic pancreatitis