GENERAL SURGERY

ACUTE PANCREATITIS

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Be able to discuss three differentials of epigastric pain and three causes of pancreatitis
Understand the key investigations required for the diagnosis and severity-stratification of someone with pancreatitis
Be able to prescribe appropriate management for a patient diagnosed with pancreatitis

Explain structure of session

Total time:

60 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Beth Brockbank

Uploaded:

19th September 2019

Last updated:

19th September 2019

Resources needed for this session:

Prescription chart, pen, paper

Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.

Resources linked to this session:

Activity 1: History Taking Skills

10 min

Ask the student(s) to spend 10 minutes taking a history from the patient. Ask them to focus on identifying the key symptoms of pancreatitis and identifying clues to possible causes.

For a group of two or more students consider assigning the following roles:

one student to take the history
one to observe and present the history
one to observe and provide feedback to the student on history taking
one scribe to document the history

Activity 2: Diagnostic Reasoning

10 min

Ask the student or observer to briefly present the key findings of the case.

Feedback to the student on presentation style (max 1 minute).

Discuss:

differentials diagnoses for epigastric pain (see reference 1 for examples)
causes of pancreatitis
pathophysiology of pancreatitis (if time allows)

Activity 3: Initial Investigations and Risk-Stratification

10 min

Ask the student(s) to suggest and justify some initial investigations. Try to clarify whether these are diagnostic investigations (i.e. to confirm the diagnosis) or to establish the underlying cause (some tests may be useful for both).

Review the patient’s own results or these below. Using these results, ask students to calculate a Glasgow Score for the patient. The QR code opposite links to the mdcalc scoring calculator.

Hb 123

MCV 102

WCC 23

CRP 98

Urea 8.0

Creat 67

ALT 65

ALP 440

LDH 780

Calcium 2.3

Albumin 61

pH 7.45

O2 11.2

CO2 4.5

Lactate 3.0

Activity 4: Prescribing

10 min

Ask students to find a blank drug chart. Imagine they are the junior doctor assessing the patient on presentation to the emergency department. The patient is stable, but looks dehydrated and unwell, with a blood pressure of 95/60mmHg ad heart rate of 100bpm.

Ask them to prescribe the following treatments.

IV fluids for resuscitation and 24 hours of maintenance
appropriate analgesia
an appropriate antiemetic

Consider the circumstances in which antibiotics may be indicated in acute pancreatitis. If relevant, ask students to prescribe an appropriate antibiotic.

Review the students prescriptions when complete and answer any queries they may have.

Activity 5: Further Management

10 min

Ask students to find the local hospital policy on management of patients with acute pancreatitis. Compare this with the treatment the patient received.

Consider:

Were any treatments missed, or done differently? Why might this be?
When might it be appropriate to move the patient to a high dependency unit or intensive care?
Summarise the key aspects of management of a patient with acute pancreatitis.
What further tests might be required to determine the underlying cause of acute pancreatitis?