• 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
• 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
• 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
• 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)
• 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
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
