Approach To Hepatobiliary Pt Flashcards
What is the diagnostic criteria for acute pancreatitis?
At least 2 of the 3:
- epigastric pain
- lipase (and amylase) 3x the ULN
- CT changes consist with pancreatitis
What is “sentinel loop” sign on abd x-ray?
Segment of air filled small intestine (most commonly in the LUQ)
Associated with acute pancreatitis
What is the “colon cutoff” sign on abd x-ray?
Gas filled segment of transverse colon abruptly ending at the area of pancreatic inflammation
Associated with acute pancreatitis
What is the treatment for severe acute pancreatitis (SAP)?
Early surgical consult (treatment of complications),
ICU,
Give Ca gluconate IV for hypocalcemia with tetany,
FFP for coagulopathy,
Serum albumin infusions for hypoalbuminemia,
Use vasopressin if fluid resuscitation isnt helping for shock (hypovolemic),
Within 48 hours of admission start enteral feedings with nasogastric tube (reduces risk of multi organ failure and mortality)
What is the Ranson criteria?
Assessing severity of acute pancreatitis
What is APACHE II?
Acute physiology and chronic health evaluation
Not just for pancreatitis (ICU scoring system that predicts hospital mortality)
>8 = higher mortality
What is BISAP?
Bedside index for severity in acute pancreatitis (BISAP)
BUN >25, impaired mental status, SIRS, age >60 and pleural effusion
Scale 0-5; mortality < 1% for BISAP of 0 to 1, and up to 27% for score of 5
What is emphysematous pancreatitis?
Infected pancreatic necrosis with secondary gas formation
Examples of gas forming GI organisms: Clostridium perfringens, enterobacter aerogenes, enterococcus faecalis
What causes concern for pancreatic cancer?
Tumefactive chronic pancreatitis
What other conditions can also cause elevated amylase?
High intestinal obstruction,
Gastroenteritis,
Mumps (not involving pancreas - salivary amylase),
Ectopic pregnancy,
Administration of opioids,
After abdominal surgery
Lipase is considered more accurate for pancreatic source than what?
Amylase
What are protective factors for cholelithiasis?
Cardiorespiratory fitness,
Low carb diet,
Physical activity,
Consumption of caffeinated coffee (in women),
High intake of Mg and polyunsaturated and monounsaturated fats (in Men),
High fiber diet and statin therapy,
ASA and NSAIDs
What is the window period?
Between HBsAg disappearing and HBsAb appearing which may be several weeks-months, but the pt still is considered to have acute HBV and the infection is detectable with the HBcAb IgM
What is the serology for the window period of hepatitis B?
What is the serology for an acute infection of hepatitis B?
What is the serology for a prior infection of hepatitis B?
What is the serology for an inactive chronic infection of hepatitis B?
What is the serology for an active flare of a chronic infection of hepatitis B?
What is the serology for immunization to hepatitis B?
Explain the components used in serology
