Pancreatitis

A 35-year-old female presents to the emergency department (ED) with a sudden onset of central abdominal pain and tenderness. Pulse is 90 bpm, BP 120/80 mmHg, SaO2 99% and RR 14. Blood results reveal an amylase of 800, and a diagnosis of pancreatitis is made.

Which of the following do you inform the patient?

A 48-year-old female presents to the ED with upper abdominal pain and vomiting. She is found to have a significantly raised amylase level and a diagnosis of acute pancreatitis is made.

Which of the following is correct regarding the pathophysiology of acute pancreatitis?

A 55-year-old male, who has a known heavy alcohol intake, presents to the ED with epigastric pain and vomiting.

With regards to clinical examination of a patient with pancreatitis, which of the following statements is correct?

Following 24 hours as an inpatient, a 57-year-old male who has been diagnosed with a likely gallstone related pancreatitis is assessed during the surgical ward round.

Which of the following would suggest that this patient had acute severe pancreatitis?

Which of the following is true regarding serum amylase levels?

In terms of establishing the diagnosis and guiding management of acute pancreatitis which of the following is true of imaging techniques?

A 42-year-old female presents with upper abdominal pain. The pain radiates to her back. She is known to have a history of gallstone disease. Acute pancreatitis or cholecystitis is suspected. She is haemodynamically stable and is apyrexial.

What would be an appropriate management step within the ED?

A 65-year-old male with a history of excessive alcohol intake presents with acute confusion and abdominal pain. He is apyrexial, heart rate is 126 bpm, blood pressure 98/45 mmHg, respiratory rate is 28, SaO2% 93 on room air.

What should the initial management include?

A 71-year-old male is admitted with upper abdominal pain and vomiting. The patient has mild abdominal tenderness on examination. Also, a temperature of 37.6oC, decreased air entry to both bases on auscultation and a pulse of 100 bpm. Past medical history includes hypertension on amlodipine. The patient is admitted to surgical HDU.

After 12 hours the patient deteriorates; heart rate increases to 120 bpm, blood pressure is 85/40 mmHg, SaO2% 99 on FiO2 of 60%, temperature is 38.2oC.

What should further management include?

The same patient receives a fluid challenge, which does improve blood pressure marginally. The patient is noted to become anuric despite a repeat fluid challenge, however the blood pressure remains marginally improved at 90/47 mmHg with a heart rate of 110 bpm. The decision is made to insert both a central and arterial line in this patient. From the arterial line you take a blood sample which when analysed reveals: pH 7.28, HCO3 10, PCO2 2.8, PO2 10.4, Lac 6.2, Na 138, K 5.6.

Which of the following should be your priority?