foreign [Applause] [Music] ers.com in this video I'm going to be going through pancreatitis and you can find written notes on this topic at zeroefinals.com pancreatitis or in the general surgery section of the zero to finals surgery book so let's jump straight in pancreatitis refers to inflammation of the pancreas and it can be categorized as acute pancreatitis or chronic pancreatitis this section mainly relates to acute pancreatitis acute pancreatitis presents with a rapid onset of inflammation and symptoms after an episode of acute pancreatitis normal function usually returns to the pancreas chronic pancreatitis involves longer term inflammation and symptoms with a progressive and permanent deterioration in pancreatic function so what are the causes of pancreatitis the three key causes of pancreatitis to remember are gallstones alcohol [Music] and ercp procedures gallstones pancreatitis is caused by gallstones getting trapped at the end of the biliary system at the ampulla of Veda and blocking the flow of bile and pancreatic juice into the duodenum the reflux of bile into the pancreatic duct and the prevention of pancreatic juice containing enzymes from being secreted results in inflammation in the pancreas gallstones pancreatitis is more common in women and older patients alcohol is directly toxic to pancreatic cells and this can result in inflammation and pancreatitis alcohol-induced pancreatitis is more common in men and younger patients there's a popular mnemonic that goes I get smashed for remembering a long list of causes of pancreatitis I refers to idiopathic G refers to gallstones e refers to ethanol or alcohol consumption T refers to trauma s refers to steroids M refers to mumps infection a refers to autoimmune s refers to scorpion sting and this is one that everybody remembers but is never relevant H refers to hyperlipidemia e refers to ercp procedures and D refers to drugs particularly Furosemide thiazide diuretics and azathiopine so let's talk about the presentation acute pancreatitis typically presents with an acute onset of severe epigastric pain this pain May radiate through to the back it can be associated with vomiting there's abdominal tenderness and the patient is systemically unwell for example having a low-grade fever and tachycardia or a fast heart rate acute pancreatitis is a clinical diagnosis based mainly on the presenting features and the amylase level so let's talk about the investigations initial investigations are required as with any presentation of an acute abdomen importantly these investigations need to include the blood tests that are required for calculating the Glasgow score which we'll talk about shortly a full blood Crown is required for the white cell count using ease blood test is required for the urea level liver function tests are required for the transaminases and the albumin level a blood calcium is required and an arterial blood gas or ABG is required for the pao2 and the blood glucose level amylase is the blood test to remember for pancreatitis it's raised more than three times the upper limit of normal in acute pancreatitis in chronic pancreatitis the amylase may not rise because the pancreas has reduced function a C-reactive protein or CRP blood test can be used to monitor the levels of inflammation in the body this is a very non-specific blood test which can be raised with any cause of inflammation an ultrasound scan is the initial investigation of choice for assessing for gallstones in patients with suspected gallstones pancreatitis however it's not very useful for visualizing the pancreatitis itself a CT of the abdomen can assess for complications of pancreatitis such as necrosis abscesses and fluid collections it's not usually required unless complications are suspected for example the patient is becoming more unwell let's talk about the Glasgow score the Glasgow score is used to assess for the severity of the pancreatitis it gives a numerical score based on how many of the key criteria are present a score of zero or one indicates mild pancreatitis a score of 2 indicates moderate pancreatitis and a score of three or more indicates severe pancreatitis the criteria for the Glasgow score can be remembered using the pancreas mnemonic and you give one point for each answer that's true P refers to pao2 or a partial pressure of oxygen that's less than 8 kPa a refers to age above 55 n refers to neutrophils and this is a white blood cell count above 15. C refers to calcium and this is when the calcium is less than two R refers to the blood urea level being more than 16. e refers to enzymes specifically the LDH enzyme being more than 600 or the AST or alt being more than 200 a refers to albumin being less than 32 and S refers to Sugar referring to the blood glucose level being more than 10. so let's talk about the management of acute pancreatitis patients with acute pancreatitis can become very unwell rapidly they require admission for supportive management moderate or severe cases should be considered for management on the high dependency unit or hdu or the Intensive Care Unit or ICU management involves initial resuscitation with an ABCDE approach IV fluids making the patient nil by mouth analgesia careful monitoring treatment of gallstones if there's gallstones pancreatitis for example with an ercp procedure or a cholecystectomy antibiotics may be used if there's evidence of a specific infection for example an abscess or an infected necrotic area of the pancreas and treatment of any complications for example if there's a large collection that develops this can be drained either by an endoscopic or a percutaneous procedure most patients will improve within three to seven days when they present with acute pancreatitis and have proper treatment let's talk about the complications of acute pancreatitis these include necrosis of the pancreas infection in a necrotic area of the pancreas the formation of an abscess acute peripancreatic fluid collections pseudocysts which are collections of pancreatic juice which can develop four weeks after the acute pancreatitis and finally chronic pancreatitis so let's talk in more detail about chronic pancreatitis chronic pancreatitis refers to chronic inflammation in the pancreas it results in fibrosis and a reduced function of the pancreatic tissue Alco is the most common cause of chronic pancreatitis it presents with similar symptoms to acute pancreatitis but generally the symptoms are less intense and longer lasting key complications are chronic epigastric pain a loss of exocrine function of the pancreas resulting in a lack of the pancreatic enzymes particularly lipase which are normally secreted into the gastrointestinal tract a loss of the endocrine function of the pancreas resulting in a lack of insulin leading to diabetes damage and strictures to the duct system resulting in obstruction in the excretion of pancreatic juice and bile and the formation of pseudocysts or abscesses so what's the management of chronic pancreatitis first of all the patient needs to abstain from alcohol and smoking which is really important in managing the symptoms and the complications analgesia can be used to manage pain although it can be severe and very difficult to manage patients may require replacement of the pancreatic enzymes particularly lipase with tablets called Creon if there is a loss of these pancreatic enzymes otherwise a lack of enzymes leads to malabsorption of fat greasy stools which is called steeteria and deficiency in fat soluble vitamins if patients develop diabetes they require subcutaneous insulin regimes if the patient has strictures and obstruction to the biliary system and the pancreatic duct and ercp procedure with stenting can be used to treat these and surgery may be required by specialist centers to treat complications that develop such as severe chronic pain where the patient may benefit from draining the ducts and removing inflamed pancreatic tissue obstruction of the biliary system and the pancreatic duct pseudocysts and abscesses if you like this video consider joining the zero to finals patreon account where you get early access to these videos before they appear on YouTube you also get access to my comprehensive course on how to learn medicine and do well in medical exams digital flash cards for rapidly testing the key facts you need for medical exams early access to the zero to finals podcast episodes and question podcasts which you can use to test your knowledge on the go thanks for watching and I'll see you in the next video