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GI - 2 > Pancreatic Patient > Flashcards

Pancreatic Patient Flashcards

1
Q

Is Acute Pancreatitis an emergency?

A

YES

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2
Q

What occurs with Acute Pancreatitis?

A

Activation of digestive enzymes = autodigestion

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3
Q

What are common causes of Acute Pancreatitis?

A

Gallstones
Heavy alcohol use
Hypertriglyceridemia
Trauma, meds

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4
Q

Symptoms of Acute Pancreatitis?

A

Epigastric/RUQ pain that radiates straight through to the back

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5
Q

Where does the pain radiate with Acute Pancreatitis?

A

Straight through to the back

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6
Q

What may be seen on the skin with Acute Pancreatitis?

A

Cullen sign = belly bruise

Grey Turner Sign = flank bruise

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7
Q

Abdominal exam findings with Acute Pancreatitis?

A

Abdominal tenderness with decreased bowel sounds

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8
Q

What may be found with a lung exam with Acute Pancreatitis?

A

Possible difficulty breathing with crackles due to pleural effusions

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9
Q

What ion will be decreased with Acute Pancreatitis and what are the corresponding (+) findings?

A

HYPOcalcemia
= Chvostek sign and Trousseau sign (+)
Chvostek - facial nerve spasm
Trousseau - bp cuff causes carpal spasm

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10
Q

What are the diagnostic criteria for Acute Pancreatitis?

A

2/3 of the following:

  1. Epigastric pain
  2. CT changes consistent with pancreatitis
  3. Lipase (and amylase) 3X the upper limit of normal
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11
Q

What are the diagnostic criteria for Acute Pancreatitis?

A

2/3 of the following:

  1. Epigastric pain
  2. CT changes consistent with pancreatitis
  3. Lipase (and amylase) 3X the upper limit of normal
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12
Q

Difference between Lipase and Amylase?

A

Amylase can be increased in other conditions

= LIPASE IS MORE ACCURATE

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13
Q

Difference between Lipase and Amylase?

A

Amylase can be increased in other conditions

= LIPASE IS MORE ACCURATE

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14
Q

A CT with or without contrast can be obtained for Acute Pancreatitis. When should you avoid using contrast?

A

Cr > 1.5

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15
Q

What are 2 things that may be seen on X-ray with Acute Pancreatitis?

A

Sentinel Loop

Colon Cutoff Sign

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16
Q

What are 2 things that may be seen on X-ray with Acute Pancreatiits?

A

Sentinel Loop

Colon Cutoff Sign

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17
Q

Sentinel loop

A

Segment of air-filled small intestine in LUQ

- Sign of Acute Pancreatitis

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18
Q

Colon Cutoff Sign

A

Gas-filled segment of transverse colon that ABRUPTLY ends at area of Pancreatic inflammation

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19
Q

What are possible complications of Acute Pancreatitis?

A
  • Intravascular volume depletion
  • Necrosis with possible infection
  • Acute Respiratory Distress Syndrome, Pleural Effusion
  • Ileus with fluid-filled loop
  • Pseudocysts, pancreatic ascites, chronic pancreatitis
20
Q

What are possible complications of Acute Pancreatitis?

A
  • Intravascular volume depletion
  • Necrosis with possible infection
  • Acute Respiratory Distress Syndrome, Pleural Effusion
  • Ileus with fluid-filled loop
  • Pseudocysts, pancreatic ascites, chronic pancreatitis
21
Q

First treatment for Acute Pancreatitis?

A

IV FLUID RESUSCITATION

22
Q

First treatment for Acute Pancreatitis and what is may worsen?

A

IV FLUID RESUSCITATION

- may worsen pain and acute respiratory distress syndrome

23
Q

If severe acute pancreatitis, what should be given for treatment?

A
  • IV Calcium Gluconate for hypocalcemia
  • fresh frozen plasma and albumin
  • enteral feedings
24
Q

What are 4 severity indicators for Acute Pancreatitis?

A
  • GA-LAW
  • C and HOBBS
  • APACHE II > 8 = higher mortality
  • BISAP score (0-5)
25
Q

What is Chronic Pancreatitis?

A

Irreversible damage to pancreas

- necrosis -> fibrosis

26
Q

Causes of Chronic Pancreatitis?

A

TIGAR-O

  • Toxic-metabolic – usually alcohol
  • Idiopathic – smoking is risk factor
  • Genetic
  • Autoimmune – celiac/IgG4
  • Recurrent acute pancreatitis
  • Obstruction
27
Q

Causes of Chronic Pancreatitis?

A

TIGAR-O

  • Toxic-metabolic – usually alcohol
  • Idiopathic – smoking is risk factor
  • Genetic
  • Autoimmune – celiac/IgG4
  • Recurrent acute pancreatitis
  • Obstruction
28
Q

Symptoms of Chronic Pancreatitis?

A

Chronic/intermittent epigastric pain

Pancreatic insufficiency

29
Q

Symptoms of Chronic Pancreatitis?

A

Chronic/intermittent epigastric pain

Pancreatic insufficiency

30
Q

Chronic pancreatitis often has pancreatic insufficiency. What are the signs of exocrine and endocrine insufficiency?

A 
Exocrine = steatorrhea
Endocrine = diabetes mellitus
31
Q

Chronic Pancreatitis often has pancreatic insufficiency. What are the signs of exocrine and endocrine insufficiency?

A 
Exocrine = steatorrhea
Endocrine = diabetes mellitus
32
Q

Fecal changes that are reflective of pancreatic insufficiency with Chronic Pancreatitis?

A

Fecal fat INCREASED

Fecal chymotrypsin and elastase DECREASED

33
Q

What will be seen on imaging with Chronic Pancreatitis?

A

CALCIFICATIONS

34
Q

What will be seen on imaging with Chronic Pancreatitis?

A

CALCIFICATIONS

35
Q

Possible complications of Chronic Pancreatitis?

A

Pancreatic cancer

Pancreatic insufficiency – diabetes

36
Q

Pancreatic cancer is usually what type?

A

Adenocarcinoma

37
Q

Where are tumors usually located with pancreatic cancer and the resulting signs?

A

Pancreatic head

-> biliary obstruction -> jaundice

38
Q

Signs of Pancreatic Cancer?

A 
Painless jaundice (maybe epigastric to back pain)
NEW onset diabetes mellitus in an older person
39
Q

Signs of Pancreatic Cancer?

A 
Painless jaundice (maybe epigastric to back pain)
NEW onset diabetes mellitus in an older person
40
Q

What signs will be (+) with Pancreatic Cancer?

A

Trousseau sign of malignancy - migratory thrombophlebitis

Courvoisier sign

41
Q

Courvoisier sign

A

Enlarged, non-tender gallbladder due to underlying mass

- sign of pancreatic cancer

42
Q

What marker will be increased with Pancreatic Cancer?

A

CA 19-9

43
Q

What marker will be increased with Pancreatic Cancer?

A

CA 19-9

44
Q

Treatment for Pancreatic Cancer?

A 
Whipple surgery (removes head of pancreas)
Chemo
45
Q

Amylase of Lipase - which is more accurate to the pancreas?

A

LIPASE

GI - 2 (61 decks)

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