12 Questions
What is the characteristic of abdominal pain in acute pancreatitis?
Epigastric and constant
Why should pethidine alone be avoided in the management of acute pancreatitis?
It can cause spasm of the sphincter of Oddi
What is a complication of acute pancreatitis?
Multi-organ failure
What is the purpose of Ranson's criteria?
To determine the prognosis of acute pancreatitis
What is a sign of intra/retroperitoneal bleeding in acute pancreatitis?
All of the above
What is a common symptom of acute pancreatitis?
Nausea and vomiting
What is the primary mechanism of acute pancreatitis?
Autodigestion of acinar cells by activated enzymes
Which of the following laboratory tests is more specific for acute pancreatitis?
Serum lipase
What is the primary goal of the 'R-Regimen' in treating acute pancreatitis?
Relieve pain and rest the bowel
What is the most common cause of acute pancreatitis?
Gallstones
What is the radiological sign of acute pancreatitis on an abdominal X-ray?
Colon cut off sign
What is the primary role of IV fluids in the treatment of acute pancreatitis?
Resuscitate the patient
Study Notes
Definition and Pathophysiology of Acute Pancreatitis
- Acute pancreatitis is the autodigestion of acinar cells of the pancreas by its own regurgitated enzymes in their active form.
- Obstruction of the pancreatic duct leads to the return of pancreatic enzymes, causing autodigestion and destruction of acinar cells.
Causes of Acute Pancreatitis
- Idiopathic
- Steroid
- Mumps/Malnutrition/Malignancy
- Gallstones (1st)
- Autoimmune
- Ethanol (alcohol) (2nd)
- Scorpion/Spider bites
- Trauma
- Hyperlipidemia/Hypercalcemia/Hereditary
- ERCP
- Drugs/Duodenal obstruction
Investigations for Acute Pancreatitis
- Labs: CBC (↑WBC), Serum amylase, Serum lipase, & Urinary amylase
- Imaging: Abdominal X-Ray, Ultrasound, & Enhanced - CT-scan
- Serum lipase is more specific for acute pancreatitis, but not routinely done due to high cost.
Abdominal X-Ray Signs
- Colon cut off sign
- Sentinel loop
Enhanced - CT-Scan Signs
- Pancreatic necrosis
- Peri-pancreatic fluid
Treatment of Acute Pancreatitis ("R-Regimen")
- Rest: Relieve Pain, NPO, IV fluid, electrolytes replacement
- Rest: Rest the bowel (NG tube to decompress the bowel)
- Resist: Resist infection
Signs and Symptoms of Acute Pancreatitis
- Symptoms:
- Abdominal pain (SOCRATES)
- Nausea, vomiting
- Dull, boring pain
- Signs:
- Abdominal distension
- Jaundice
- Inflammatory symptoms (FAHM)
- Inflammatory signs (HTT)
- Muscle guarding in upper abdomen & Rebound tenderness
- Fox sign (Bruising in the inguinal ligament)
- Grey Turner sign (Ecchymosis in the flanks)
- Cullen's sign (Ecchymosis in the peri-umbilical region)
Complications of Acute Pancreatitis
- Multi-organ failure
- Abscess formation
- Pancreatic pseudocyst
- Recurrent acute attacks
- Chronic Pancreatitis
- Dehydration, Electrolyte Imbalance, Acid-Base Imbalance, and Renal Impairment
- Hemorrhagic, necrotic, and infective presentations
- Hyperlipidemia
- Hypocalcemia
Ranson's Criteria
- A scale used to determine the prognosis of acute pancreatitis
Test your knowledge about acute pancreatitis, its definition, pathophysiology, causes, and investigations. Learn about the auto-digestion of pancreatic cells and obstruction of the pancreatic duct. Get ready to diagnose and manage this condition!
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