1. Mateja Grizelj Mentor: A. Žmegač Horvat
Pancreatitis
Mateja Grizelj
Mentor: A. Žmegač Horvat

2. Case 40-year-old woman with a 4-day history of
epigastric pain with radiation to the back. She
has been vomiting, and on examination there is
tenderness with guarding in the epigastrium.
There have been no previous similar attacks.
The serum amylase is 798 U/L (normal <125
U/L).

3. Classification
Acute pancreatitis
Chronic pancreatitis

4. Acute pancreatitis Pathogenesis : Gallstones Alcohol Idiopathic
Hypercalcaemia, hyperlipidaemia
Post-surgical, post-ERCP
Drugs

5. Clinical features Epigastric, upper abdominal pain Nausea, vomiting
Epigastric tenderness, guarding and rigidity
Ascites
Cullen´s sign, Grey Turner´s sign – ecchymoses
Multiorgan failure

6. Diagnosis Blood test - raised serum amylase Radiology:
1.X-ray (to exclude peptic ulcer)
2.Ultrasound – gallstones
3.Contrast-enhanced spiral CT or MRI – pancreatic necrosis

7. Glasgow criteria Age >55 yrs WBC count >15 x109/L
Blood glucose >200 mg/dL (no diabetic history)
Serum urea >16 mmol/L (no response to iv. fluids)
Arterial oxygen saturation <76 mmHg
Serum calcium <2 mmol/L
Serum albumin <34 g/L
LDH >219 units/L
AST/ALT >96 units/L

8. Treatment ERCP, stone removal
Prophylactic antibiotics: cefuroxime or aztreonam
Analgesia: pethidine or tramadol, NOT morphine (increases sphinter of Oddi preasure – may aggravate pancreatitis)
Feeding: nasojejunal tube
Surgery

9. Complications and prognosis
Hyperglycaemia, hypocalcaemia
Renal failure
Shock
Mortality
Mild cases - 1%
Severe cases - 50%

10. Chronic pancreatitis Irreversible morphological change
Impairment of function
Chronic calcifying pancreatitis
Alcohol

11. Clinical features Abdominal pain Severe weight loss Diabetes
Steatorrhoea
Icterus
Pseudocysts

12. Diagnosis
Radiology: x-ray, CT, ultrasound
Biochemical tests

13. Treatment Stop drinking alcohol Analgesia Surgery
Pancreatic supplements

14. Case 40-year-old woman with a 4-day history of
epigastric pain with radiation to the back. She
has been vomiting, and on examination there is
tenderness with guarding in the epigastrium.
There have been no previous similar attacks.
The serum amylase is 798 U/L (normal <125
U/L).
What is the most likely diagnosis?
What further specific questions would you ask to determine the aetiology?

15. References Interna medicina, Božidar Vrhovac
Kumar and Clark`s Clinical Medicine, Parveen Kumar and Michael Clark