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CDM > Case- Pancreatitis > Flashcards

Case- Pancreatitis Flashcards

1
Q

What signs to look for in suspected pancreatitis?

A 
Epigastric tenderness to palpation
Voluntary guarding
Can be hypotensive 
Cullen Sign
Grey-Turner sign
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2
Q

Which test is more sensitive for pancreatitis in pts w/ETOH pancreatitis & Hypertriglyceridemia: Amylase or Lipase?

A

Lipase

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3
Q

Which test remains elevated longer? (8-14d) Amylase or Lipase?

A

Lipase

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4
Q

Which test is more specific for acute Pancreatitis? Amylase or lipase?

A

Lipase

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5
Q

Elevations of Lipase in Acute Pancreatitis?

A

3x > ULN

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6
Q

What are the normal levels of Amylase & Lipase?

A

Amylase:35-118
Lipase: 0-160

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7
Q

Two imaging modalities for Dx Acute Pancreatitis

A

Abdominal CT w/Contrast

Abdominal U/S

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8
Q

Dx of acute pancreatitis requires 2/3 of what?

A
  • Acute onset of persistent, severe, epigastric pain often radiating to the back
  • Elevation in serum lipase OR amylase 3x or greater than the ULN
  • Characteristic findings of acute pancreatitis on imaging
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9
Q

Dx of acute pancreatitis requires 2/3 of what?

A
  • Acute onset of persistent, severe, epigastric pain often radiating to the back
    • Elevation in serum lipase OR amylase 3x or greater than the ULN
  • Characteristic findings of acute pancreatitis on imaging
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10
Q

4 Common etiologies for pancreatitis?

Most common?

A

-Gallstones (MC 40-70%)
-ETOH
(uncommon if not a heavy drinker for >5yrs)
-Hyperlipidemia
(serum TG >1000)
-Post-ERCP

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11
Q

Mild Pancreatitis

A

No organ failure, no local/systemic complications

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12
Q

What are the local complications of Acute Pancreatitis

A
  • Acute peripancreatic fluid collection
  • Pancreatic pseudocyst
  • Necrosis
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13
Q

What are the sytstemic complications of Acute Pancreatitis

A

Examples of systemic complications are exacerbations of underlying comorbidities

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14
Q

Moderate Pancreatitis

A

No organ failure
or
transient organ failure is <48 hours
and/or local complications

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15
Q

Severe Pancreatitis

A

Persistent organ failure
(>48 hours)
involving 1+ organs

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16
Q

Edematous Pancreatitis vs Necrotizing Pancreatitis

A

Most cases of acute pancreatitis are:
acute interstitial edematous pancreatitis

20% will become necrotizing pancreatitis.

Necrotizing pancreatitis has worse outcomes,
can also become secondarily infected (with bacteria or fungus)

17
Q

Scoring systems for severity/risk of pancreatitis. Accuracy?

A

Ranson’s criteria, APACHE II score, SIRS score, BISAP score, harmless acute pancreatitis score, CT severity index

None have great accuracy.

18
Q

Initial management of Acute Pancreatitis

LR or NS?

A

Aggressive fluids for the first 24-48 hours!

LR!

19
Q

Benefits of aggressive LR & fluid replacement in acute pancreatitis?

A

LR:
reduces incidence of SIRS,
reduction in hospital stay
ICU admissions

  • Fluid replacement is associated with reduction in M&M.
  • Fluid resuscitation also helps with pain control (hypovolemia can worsen ischemia & pain)
20
Q

Clues to knowing you have adequately resuscitated the patient? (5)

A
  • normalization of HR
  • Normalization of BP,
  • Increase urine output,
  • reduction in H&H
  • Reduction in BUN
21
Q

Pain control?

A

Opioids (IV)

Hydromorpine or Fentanyl

22
Q

ABX?

A

not recommened

23
Q

Nutrition?

A

NPO during work up

24
Q

Management for Gallstones

A

ERCP early on (<24 hours) if they have gallstone pancreatitis + cholangitis.

Cholecystectomy after recovery in all pts with gallstone pancreatitis

25
Q

Management of Hypertriglyceridemia

A

severe restriction of dietary fat. Consider plasmapheresis.

26
Q

Rx admin to decrease TG if plasmaparesis unavailable

A

IV insulin administration

27
Q

Long term Tx for management of Hypertriglyceridemia

A

lipid management w/ Rx therapy
+ dietary modification
+ weight loss

28
Q

T/F: Patients with acute pancreatitis are at risk for developing prediabetes and diabetes after their first episode of acute pancreatitis.

A

True

29
Q

T/F: WBC often elevated in Acute Pancreatitis

A

True

30
Q

Nutrition if:

moderate to severe pancreatitis and oral feeding not tolerated

A

enteral feeding
(nasogastric tube)
if they can’t tolerate oral feeding by day 5.

31
Q

Nutrition if:

patient doesn’t have an ileus, nausea, or vomiting

A

resume oral intake within 24 hours if tolerated.

Start with:

  • low residue
  • low fat
  • soft diet
  • advance cautiously as tolerated.
32
Q

Acute Pancreatitis management if etiology is gallstones?

A

cholecystectomy

ERCP

33
Q

T/F: If Pancreatitis is from ETOH it can be recurrent?

A

True

34
Q

Heavy drinking is how many drinks for men/women per week?

A

7 Women

14 Men

35
Q

T/F: Acute Pancreatitis presents better with laying down & worse when sitting up?

A

False.

Opposite.

36
Q

Revised Atlanta criteria for mild, moderate and severe pancreatitis?

A
37
Q

I GET SMASHED

Acronym for Acute Pancreatitis

A

I- idiopathic

G- GALLSTONES (40-70%)
E- ETOH
T- Trauma

S-steroids
M-mumps
A- autoimmune
S-Scorpion sting
H-Hypertriglyceremia
E- ERCP
D- Drugs- SULFA

*also pregnancy, pancreatic cancer, genetic mutations,

38
Q

What can a CT with show for pancreatitis by gallstones

A

Diffuse pancreatic enlargement with edema and Perihepatic fat stranding

39
Q

What can inadequate hydration lead to in acute pancreatitis?

A

-hypotension
-ATN
-reduction in other organ perfusion
(possibly leading to necrosis)
-Ischemia
-Pain

CDM (16 decks)

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