Pancreatitis

Question 1

What are the patterns of pain for patients presenting with acute pancreatitis?

Answer 1

• sever epigastric pain
• worse after eating
• classically radiating into the back
• relieved on bending forward

Question 2

What other symptoms may be associated with acute pancreatitis?

Answer 2

• N&V
• Sx of shock - tachy, hypotension, drowsy, olig/anuria
• abdo tenderness/guarding/distension
• RARE - specific bruising patterns

Question 3

What is the typical blood test associated with pancreatitis?

Answer 3

-LIPASE > 3 times the upper limit is highly indicative of pancreatitis
(amylase is used in some trusts)

Question 4

What other findings would suggest pancreatitis?

Answer 4

• increased serum pancreas enzyme
• increased haematocrit due to volume losses in the third space
• USS - pancreas swelling
• CT - enlarged pancreas

Question 5

What is gold standard imaging + treatment option for a vast majority of acute pancreatitis patients?

Answer 5

• endoscopic retrograde cholangiopancreatography

- images pancreas and allows for the removal of gall stones in the pancreatic ducts

Question 6

What are the causes of acute pancreatitis?

Answer 6

I GET SMASHED

Idiopathic

Gall stones
Ethanol
Trauma

Steroids
Mumps
Autoimmune 
Scorpion poison
Hyperglycaemia 
ERCP
Drugs (azothioprine)

Question 7

What are the important principles in treating pancreatitis?

Answer 7

• FLUIDS FLUIDS FLUIDS
• enteral feeding
• pain relief - strong shit - fentanyl
• surgery if surgical cause
• Abx if evidence of necrosis

Question 8

What risk score is used in pancreatitis? what is it good for?

Answer 8

-PANCREAS score 
Pao2<8
Age >55
Neutrophils
Calcium
Renal function (urea >16)
Enzymes (LDH/AST)
Albumin (low)
Sugar (high)

-predicting the severity of attack w/in the first 48 hours

Question 9

How does aiteology differ between acute and chronic pancreatitis?

Answer 9

obviously more insidious disease process in chronic pancreatitis

• chronic alcohol use
• cystic fibrosis
• long standing ductal blockage
• tobacco use
• idiopathic
• hereditary

Question 10

How would chronic pancreatitis present?

Answer 10

• with or without pain
• pain isn’t as intense as acute
• still epigastric and maybe radiating to the back

More evidence of pancreatic insufficiency

• steatorrhea
• diarrhoea
• weight loss
• signs of diabetes
• bloating

Question 11

How can you diagnose a chronic pancreatitis?

Answer 11

pancreas enzymes ARE NORMAL (usually)

• Faecal elastase (steatorrhea due to pancreatic stuff)
• CT - pancreatic calcification, swelling
• ERCP - early pathology diagnosis and Tx
• USS may be helpful

Question 12

Tell me how to manage chronic pancreatitis.

Answer 12

• abstinence of alcohol and nicotine
• Enzyme replacement with meals
• pain relief - NSAIDS/opioids
• surgery if required
• ganglion block for chronic pain