Pancreatitis

Exam Cram

• Pancreatitis: inflammation of the pancreas and is acute or chronic

• Pancreatitis is largely caused by alcohol abuse and gallstones

• Acute Pancreatitis: 

  • Presentation: epigastric pain radiating to the back

  • Management: IVF, early feeding

Acute Pancreatitis Outline

Assessment

History:

• Acute history < 7d

• Epigastric pain, radiating to the back with nausea/ vomiting

• Obese- biliary stones or alcohol excess

Examination:

• Epigastric tenderness

• If hypoxic- consider ARDS

• Hypotensive, tachycardic

Investigations

• Raised amylase or lipase - more sensitivie and specific, but more expensive than amylase

• CTAP

  • • • Pancreatits can be made clinically without CT (symptoms + serum tests)

      • CTAP is more useful after 24-48hrs in pancreatitis

      • Can evaluate for pseudocysts or drainable collections

• Raised lactate, hypocalcaemia: severe

• Unremarkable LFTs

Diagnosis

Diagnostic criteria (2/3 required):

1. Symptoms: epigastric pain

2. Serum amylase or lipase raised: 3x upper limit normal

3. Radiologic evidence: pancreatitis on CTAP or MRI

Differentials: 

• Ascending cholangitis- febrile

• Perforated peptic ulcer- peritonitic, nil alcohol / gallstones history

• Mesenteric ischaemia- raised lactate, post prandial pain

Classification: 

• By cause: 90%- gallstones & alcohol

• Severity markers: Glasgow-Imrie Score

Management

• IVF

• Analgesia, antiemetics

•  Early feeding PO or NG feed

Causes of Pancreatitis

Overview

90%- gallstones & alcohol

I GET SMASHED (popular mneumonic)

I: Idiopathic

G: Gallstones

E: Ethanol, ERCP

T: Trauma, toxins

S: Steroids, scorpion bites

M: Mumps, malignancy

A: Autoimmune

S: Steroids, scorpion bites

H: Hyper-triglycerides, hypercalcaemia

E: Ethanol, ERCP

D: Drugs

Drug induced Pancreatitis

2% total pancreatitis: FAN.COMS

1. Fursemide

2. Azathiopine

3. Na Valproate

4. Corticosteroids

5. Oestrogens

6. Mesalazine

7. Sulphonamides

Toxin Causes

• Organophosphates

• Methyl-ethanol

AutoImmune Pancreatitis

• Type 1: IgG4 Related disease

• Type 2: Non Ig4 Related disease

• Differentials: pancreatic cancer

• Management: steroids

Everything else (rare)

• Burns

Chronic Pancreatitis Outline

Background

• Complication of acute pancreatitis

Assessment

History:

• Pancreatic insufficiency

  • Weight loss, anorexia

  • Loose 'fatty' stools, floating

Examination:

• Thin

Investigations

• Faecal elastase < 100

Management

• Pancreatic supplement: Creon

MED Reg Notes

Complications of acute pancreatitis

• ARDS

• Chronic pancreatitis

• Pancreatic insufficiency

• Pancreatic cancer

Analgesia

Coeliac plexus block- analgesia

Common MCQ

Presentation: vague abdo pain + amylase 1.5x upper limit of normal, not diagnostic for pancreatitis. 

Pancreatitis Severity Markers

Glasgow-Imrie Score

• Hypoxic

• Age > 55 years

• WCC > 15

• Calcium < 2.0

• Urea > 16

• LDH > 600

• Albumin < 32

• Blood glucose > 10

References

1. Mallory, A. and Kern, F. (1980) ‘Drug-induced pancreatitis: A critical review’, Gastroenterology, 78(4), pp. 813–820. doi:10.1016/0016-5085(80)90689-7.

2. Basyal B, KC P. Autoimmune Pancreatitis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560769/ 

Page written in 2024.