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Understanding Pancreatitis: Causes and Management

Apr 23, 2025

Lecture Notes: Pancreatitis

Overview of Pancreatitis

  • Definition: Inflammation of the pancreas.
  • Types:
    • Acute Pancreatitis: Rapid onset; normal function usually returns post-episode.
    • Chronic Pancreatitis: Long-term inflammation; progressive and permanent deterioration of pancreatic function.

Causes of Pancreatitis

  • Key Causes:
    • Gallstones: Block bile and pancreatic juice flow.
    • Alcohol: Toxic to pancreatic cells.
    • ERCP Procedure: Medical procedure that can lead to inflammation.
  • Mnemonic for Causes: I GET SMASHED
    • I: Idiopathic
    • G: Gallstones
    • E: Ethanol (Alcohol)
    • T: Trauma
    • S: Steroids
    • M: Mumps infection
    • A: Autoimmune
    • S: Scorpion sting
    • H: Hyperlipidemia
    • E: ERCP procedures
    • D: Drugs (e.g., Furosemide, Thiazide diuretics, Azathioprine)

Presentation of Acute Pancreatitis

  • Symptoms:
    • Severe epigastric pain, possibly radiating to the back.
    • Vomiting and abdominal tenderness.
    • Systemic signs: Low-grade fever, tachycardia.

Investigations for Pancreatitis

  • Initial Investigations:
    • Full blood count: Check white cell count.
    • U&E (Urea & Electrolytes): For urea level.
    • Liver Function Tests: Transaminases, albumin levels.
    • Blood calcium and glucose levels.
    • Amylase Test: Raised >3x normal in acute pancreatitis.
    • CRP Test: Monitor inflammation.
  • Imaging:
    • Ultrasound: First-line for gallstones.
    • CT Scan: For complications like necrosis, abscesses.

Glasgow Score

  • Purpose: Assess severity of the pancreatitis.
  • Scoring:
    • 0-1: Mild
    • 2: Moderate
    • 3 or more: Severe
  • Mnemonic for Criteria: PANCREAS
    • P: PaO2 < 8 kPa
    • A: Age > 55
    • N: Neutrophils > 15
    • C: Calcium < 2
    • R: Urea > 16
    • E: Enzymes (LDH > 600, AST/ALT > 200)
    • A: Albumin < 32
    • S: Sugar (Blood glucose > 10)

Management of Acute Pancreatitis

  • Supportive Care:
    • ABCDE approach, IV fluids, analgesia.
    • Nil by mouth.
    • Monitoring: Vital signs and organ function.
  • Specific Treatments:
    • ERCP or cholecystectomy for gallstone pancreatitis.
    • Antibiotics for infections.
  • Complications: Necrosis, abscess, fluid collections, pseudocysts, chronic pancreatitis.

Chronic Pancreatitis

  • Cause: Often due to alcohol.
  • Symptoms: Less intense but longer-lasting compared to acute pancreatitis.
  • Complications:
    • Chronic pain.
    • Loss of pancreatic enzyme function leading to malabsorption.
    • Diabetes due to loss of insulin production.
    • Pseudocysts and duct obstruction.

Management of Chronic Pancreatitis

  • Lifestyle Changes: Abstain from alcohol and smoking.
  • Medical Management:
    • Analgesia for pain.
    • Pancreatic enzyme replacement (e.g., Creon).
    • Insulin for diabetes.
  • Procedures: ERCP for duct obstructions, surgery for complications.

Additional Resources

  • Zero to Finals Patreon: Early access to videos and learning resources.
  • Zero to Finals Course: Comprehensive learning on medical topics.

Note: This lecture is based on a video from Zero to Finals, and additional resources are available for further study.

Full transcript