Acute Pancreatitis

•    Sudden inflammation of pancreas; may lead to systemic inflammatory response

•    Features: severe epigastric pain radiating to back, nausea, vomiting, tender abdomen

•    Labs: ↑ serum amylase/lipase (>3× ULN), ↑ CRP

•    Imaging:

o    CT scan (best for complications)

o    USS to assess for gallstones

•    Causes – “I GET SMASHED”:

o    Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps (and other infections), Autoimmune, Scorpion sting, Hyperlipidaemia/hypercalcaemia, ERCP, Drugs (azathioprine, thiazides)

•    Complications: pseudocysts, necrosis, ARDS, multi-organ failure

•    Management: supportive – fluids, analgesia, NBM ± antibiotics if infected necrosis

Chronic Pancreatitis

•    Progressive pancreatic fibrosis and dysfunction

•    Causes: chronic alcohol use (most common), genetic (CF, PRSS1), idiopathic

•    Features: chronic epigastric pain, steatorrhoea, weight loss, diabetes

•    Imaging: pancreatic calcifications on X-ray or CT; MRCP/ERCP may show ductal changes

•    Management:

o    Enzyme supplementation

o    Analgesia

o    Treat diabetes

o    Endoscopic or surgical interventions in selected cases

Pancreatic Cancer

•    Usually adenocarcinoma of pancreatic head

•    Features:

o    Painless obstructive jaundice (head of pancreas)

o    Weight loss, epigastric pain, new-onset diabetes

o    Courvoisier’s sign: palpable non-tender gallbladder + jaundice

•    Marker: CA 19-9 (used for monitoring, not screening)

•    Imaging: CT pancreas ± EUS-FNA for biopsy

•    Poor prognosis: most present late

•    Treatment:

o    Surgical resection if operable (Whipple’s procedure)

o    Chemotherapy/palliative care if advanced

Pancreatic Cysts

•    May be benign or premalignant

•    Types:

o    IPMN (intraductal papillary mucinous neoplasm): mucin-secreting, can become malignant

o    Mucinous cystic neoplasm: usually in women, premalignant

o    Serous cystadenoma: usually benign

•    Diagnosis: imaging (MRI, EUS), cyst fluid analysis (CEA, cytology)

•    Management: surgical resection if suspicious features 

                                    (e.g. solid components, ductal involvement, symptoms)

Endocrine Tumours of the Pancreas (NETs)

•    Arise from islet cells; may be functional or non-functional

•    Types:

o    Insulinoma: fasting hypoglycaemia, ↑ insulin + C-peptide, Whipple’s triad

o    Gastrinoma (Zollinger–Ellison syndrome): multiple refractory peptic ulcers, diarrhoea

o    Glucagonoma: necrolytic migratory erythema, diabetes, weight loss

o    VIPoma: profuse watery diarrhoea, hypokalaemia, achlorhydria ("WDHA syndrome")

o    Somatostatinoma: diabetes, gallstones, steatorrhoea

•    Diagnosis: hormone levels, imaging (CT, octreotide scan, Ga-68 PET)

•    Management: resection if localised; somatostatin analogues for symptom control