18 - Pancreatitis Flashcards Preview

GI > 18 - Pancreatitis > Flashcards

Flashcards in 18 - Pancreatitis Deck (21)
Loading flashcards...
1
Q

2 mortality peaks for acute pancreatitis

A

w/in 1-2 wks from multi organ failure

later (3+wks) from infection

2
Q

what starts the cascade of acute pancreatitis

A

conversion of typsinogen to trypsin > starts cascade of other enzymes and degrading the pancreas
cause of this first event usually unknown

3
Q

pathophys of acute pancreatitis

A

initial insult is activation of enzymes
> microcirculatory damage > edema and ischemia
disruption of pancreatic ducts
cytokines from PMNs and macrophages > systemic inflammatory response

4
Q

2 main causes of acute pancreatitis

A

gallstones (40%) and alcohol abuse (30%)

5
Q

less common causes of acute pancreatitis

A

hyperTGemia
microlithiasis/biliary sludge
drugs
hypercalcemia

6
Q

dx of acute pancreatitis

A

need 2 of:
typical sx
amylase/lipase 3x nl limits
CT findings of pancreatitis

7
Q

acute pancreatitis sx and signs

A

sx: abd pain - epigastric radiating to back, steady, mod-severe; N/V
signs: abd tenderness
Gray Turner’s sign (ecchymoses in flanks)
Cullen’s sign - periumbilical ecchymosis
tachycardia, fever
resp distress, AMS in severe cases

8
Q

which one rises quicker in acute pancreatitis - amylase or lipase?

A

amylase

9
Q

imaging modality for pancreatitis

A

CT

10
Q

Ranson’s criteria (not specfics, just general use)

A

for judging severity of acute pancreatitis

1 set for at admission, and check again at 48 hrs

11
Q

Balthazar grades

A

CT scoring guide for acute pancreatitis

12
Q

BISAP score

A

score for acute pancreatitis

BUN >25
Impaired mental status
SIRS (>2 signs)
Age >60
Pleural effusions 

> 3 has likelihood for severe pancreatitis

13
Q

management of acute pancreatitis

A

NPO (enteral feeding, not TPN)
aggressive IVF resuscitation (lactated ringer’s, maintain good urine output)
pain control (opiates)
*prophylactic abx generally NOT indicated

14
Q

local complications of acute pancreatitis

A

pseudocysts, walled off necrosis

15
Q

pathophys of chronic pancreatitis

A

loss of parenchymal cells, chronic inflammation, fibrosis

16
Q

MCC chronic pancreatitis

A

alcohol abuse

17
Q

presentation of chronic pancreatitis

A
abd pain
exocrine insufficiency (steatorrhea, wt loss, diarrhea)
endocrine insufficiency - usually later (DM, reduced glucagon)
18
Q

indirect tests for chronic pancreatitis

A

fecal elastase

fecal fat

19
Q

“gold standard” for chronic pancreatitis dx

A

ECRP - dialted pancreatic duct, filling defects, dilated side branches

20
Q

mgmt of abd pain in chronic pancreatitis

A

stop ETOH
want to avoid pain meds if possible - addiction
pancreatic enzymes - non enteric coated

21
Q

chronic pancreatitis and pancreatic adenoCA

A

4% lifetime risk of CA
inc w/ smoking
difficult to dx in setting of chronic pancreatitis - similar presentation