11. Acute Pancreatitis

Question 1

What are the exocrine functions of the pancreas?

Answer 1

• secretes 1.5 - 3 L of fluid per day
• acinar cells secrete pancreatic enzymes
• alkaline secretion to neutralize gastric acid

Question 2

What are the pancreatic enzymes and what cells produce them?

Answer 2

• proteoltic: trypsinogen
• amylolytic: amylase
• lipolytic: lipase
• secreted by the acinar cells

Question 3

What are the endocrine functions of the pancreas?

Answer 3

• α cells: glucagon
• β cells: insulin
• δ cells: somatostatin

Question 4

What is the path of secretion of the pancreas?

Answer 4

pancreatic duct → common bile duct → duodenum → enzymes activated

Question 5

What are the 3 clinical findings that indicated pancreatitis?

Answer 5

• upper abdominal pain
• serum amylase or lipase > 3x the upper limit of normal
• visualized on imaging

Question 6

What is Cullen’s sign?

Answer 6

Ecchymoses in the periumbilical region

Question 7

What is Turner’s sign?

Answer 7

Ecchymoses on the flanks

Question 8

Which enzyme remains elevated longest in pancreatitis and is a better indicator of pancreatitis?

Answer 8

lipase

Question 9

Why does biliary disease or gallstone cause pancreatitis?

Answer 9

the obstruction leads to a reflux of bile/enzymes

Question 10

Why does alcoholism cause pancreatitis?

Answer 10

• spasms of the sphincter of Oddi

- alcohol is toxic to the Acinar cells and disrupts enzyme synthesis

Question 11

What are the pancreatitis treatment measures?

Answer 11

• supportive
• nutrition
• prevention of infection
• surgery

Question 12

What is the agent of choice for fluid therapy?

Answer 12

crystalloids at 5-10 mL/kg/hr until resuscitated

- Ringer’s Lactate is preferred

Question 13

How can the pancreas be “rested”?

Answer 13

NPO

nasogastric suction

Question 14

When should oral nutrition be provided?

Answer 14

• when pain is decreased

- patient feels hungry

Question 15

What are the preferences for enteral feeding in pancreatitis?

Answer 15

• elemental or polymeric nutrition

- nasojejunal or nasogastric route

Question 16

When is parenteral nutrition indicated in pancreatitis?

Answer 16

• only if enteral is not tolerated and nutrition is needed

- very high risk

Question 17

What is the drug of choice for pancreatitis pain?

Answer 17

parenteral narcotics

• morphine
• hydromorphone
• fentanyl
• meperidine is least preferred

Question 18

What is the cause and result of spasms in the Sphincter of Oddi?

Answer 18

• cause: increase in biliary-tract pressure

- result: worsening pain/disease

Question 19

What are local complications of pancreatitis?

Answer 19

• collection of pancreatic fluid
• pseudocysts
• necrosis

Question 20

What is fluid collection and how is it resolved?

Answer 20

• a collection of pancreatic secretions
• usually resolves on its own
• persistant cysts need drainage

Question 21

What are complications of necrosis?

Answer 21

• after 1 week of disease: risk of infection
• inflammation
• hypovolemia
• hypotension
• shunting of blood

Question 22

What are the empiric agents of choice is pancreatic necrosis?

Answer 22

• carbapenems
• beta-lactams
• fluoroquinolones (+ metronidazole)

Question 23

What organisms should be considered for pancreatic necrosis?

Answer 23

• enteric gram negative rods
• anaerobes
• enterococcus

Question 24

What beta-lactams should be used empirically for pancreatic necrosis?

Answer 24

• Zosyn

- 3rd gen cephalosporins + metronidazole

Question 25

``` The sphincter of Oddi regulates outflow of fluids and enzymes between which two anatomical structures? a. Gallbladder into the Pancreas b. Duodenum into the Pancreas c. Pancreas into the Duodenum d. Liver into Pancreas ```

Answer 25

c. Pancreas into the Duodenum

Question 26

Which of the follow is NOT a main function of the pancreas? a. Secrete digestive enzymes to help break down proteins b. Store bile acids, which aid in digestion of fatty acids when released. c. Contribute to glucose regulation d. Neutralize gastric secretions

Answer 26

b. Store bile acids, which aid in digestion of fatty acids when released.

Question 27

``` Diagnosis of acute pancreatitis is made using 3 criteria, which of the following is NOT one of the 3 criteria? a. Clinical presentation b. Laboratory data c. Family history d. Imaging ```

Answer 27

c. Family history

Question 28

Medications are the most common cause of acute pancreatitis. (T/F)

Answer 28

False

Question 29

What is the most common cause of acute pancreatitis? a. Hypertriglyceridemia b. Choledocholithiasis c. Alcohol d. Medications

Answer 29

b. Choledocholithiasis