top of page

🩺 Approach to Pancreatitis: PLAB 2 Quick Guide

Updated: Aug 10


🔍 1. What is Pancreatitis?

Pancreatitis is inflammation of the pancreas — it may be:

  • Acute (sudden onset, potentially reversible)

  • Chronic (long-term, progressive damage)


🚨 2. How Does It Present?

In PLAB 2, you may meet a patient with:

🧾 Key Symptoms (history-taking clues):

  • Severe epigastric pain, sudden onset

  • Radiates to the back

  • Worse on movement, better when sitting forward

  • Nausea, vomiting

  • May follow alcohol binge or heavy meal (gallstones)


🧠 3. Common Causes

Use the mnemonic “GET SMASHED”:

  • Gallstones ✅

  • Ethanol (alcohol) ✅

  • Trauma

  • Steroids

  • Mumps

  • Autoimmune (rare)

  • Scorpion sting

  • Hypercalcaemia / Hypertriglyceridemia

  • ERCP

  • Drugs (e.g. azathioprine, valproate)

📌 Gallstones and alcohol = most common causes.


🩺 4. Examination Findings

  • Tender epigastrium

  • Tachycardia, dehydration

  • Abdominal distension

  • Rare: Grey-Turner sign (flank bruising), Cullen’s sign (periumbilical bruising) → severe cases


🧪 5. How is It Diagnosed?

You must request:

  • Serum lipase (or amylase) ≥ 3× upper limit = diagnostic

  • Bloods: FBC, U&E, LFTs, CRP

  • Imaging: Abdominal ultrasound (for gallstones), CT if severe or worsening


🛠️ 6. Management Plan (ABCDE)

In PLAB 2, your explanation must include:

Step

Action

A/B

Give oxygen, assess saturation

C

IV fluids (aggressive if hypotensive)

D

Give analgesia (opioids if needed)

E

NPO (nothing by mouth), monitor vitals, bloods

+

Treat underlying cause (e.g. gallstones = cholecystectomy later)

🧠 Mention early senior review if patient is unstable.


📅 7. Key Follow-Up Points

  • Mild pancreatitis → often resolves with supportive care

  • Severe cases → may need HDU/ICU

  • Gallstone pancreatitis → cholecystectomy before discharge

  • Complications: Necrosis, pseudocyst, infection, diabetes (chronic cases)


💬 8. How to Explain to the Patient (PLAB 2 communication)

“You have a condition called pancreatitis, which is inflammation of the pancreas. It’s usually caused by gallstones or alcohol. We’ll monitor you closely in hospital, give fluids, pain relief, and check your blood tests. You may need further treatment if we find gallstones. We’re here to help you recover.”

✅ Final PLAB 2 Tips:

  • Recognize red flags: sepsis, shock, hypoxia → urgent escalation

  • Always assess cause and communicate plan clearly

  • Don’t forget: Lipase is better than amylase


📚 References

Comments

bottom of page