Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GIT > 16feb 23 > Flashcards

16feb 23 Flashcards

(54 cards)

Start Studying
1
Q

What is peripancreatic fistula

A

Disruption of pancreatic ducts causing leakage of pancreatic digestive enzymes.
Most commonly due to acute or chronic pancreatitis.

Acute or chronic pnacreatitis cause formation of internal fistula (comm with hollow viscera or pleural/peritoneal cavities)

Iatrogenic fistulas occur after Percutaneous drainage of pancreatic cysts or abscesses and result in external fistulas (comm with skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CF of peripancreatic fistula

A

A/S
Cough
Dyspnea
Dysphagia
Chest pain

Exam: Dec breath sounds and dullness to percussion of affected lung.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PPF and pleural effusion

A

Exudative and amylase rich
Ph 7.3-7.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ttt of PPF

A

⏺Recurs after thoracentesis
⏺Bowel rest (to avoid pancreatic stimulation)
⏺ERCP with sphincterotomy
Or stent placemnet to drain pancreatic fluid in ampulla of vater
⏺ refractory cases req PCD or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PPF vs espphageal perforation

A

EP also causes amylase rich exudative pleural Effusion
But
Pleural fluid pH is very low (<6) with undigested food is present
HO severe vomiting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Exudative effusions causes

A

Infection (TB , Pneumonia )
Malignancy
Rheumatologic dx (RA, SLE)
Pulm embolism
Pancreatitis
Post CABG
Peripancreatic fistula
Boerhaave syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cause of exudative effusin

A

Inflammatory disruption of vascular permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cause of transudative effusion

A

Change in hydrostatic or oncotic pressures

Cause :
HF
Cirrhosis (hepatic hydrothorax)
Nephrotic syndrome
Constrictive pericarditis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Overview of chronic Pancreatitis

A

🐦Alcohol use
🐦Cystic Fibrosis
🐦Ductal obstruction (malignancy , stones
🐦autoimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CF of chronic pancreatitis

A

👗Chronic epigastric pain that radiates to back with intermittent pain free intervals but may become constant in adv disease.
Pain may worsen with meals
Partially relieved by sitting upright or leaning forward

👗early CP presents with acute attacks that are continuous as the dx worsens

👗Malabsorption :
Steatorrhea , weight loss

👗Diabetes Mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lab results /imaging of chrnic pancreatitis

A

🦺amylase and lipase are normal and non diagnostic

🦺 CT scan or MRCP shows calcifications , dilated ducts and enlarged pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ttt of chronic Pancreatitis

A

👘Pain management

👘Alcohol and smoking cessation

👘Freq small meals

👘Pancreatic enzyme supplements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chronic pancreatitis def and RF

A

Progressive inflammatory dx that ultimately leads to pancreatic fibrosis.
As the dx advances destruction if pancreatic islet and acinar cells leads to endocrine (diabetes) and exocrine insufficiency causing protein and fat malabsorption.

RF :
Recurrent episodes of acute panncreatitis
Alcohol abuse
Smoking
Family history (herediatry pancreatitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chronic Pancreatitis DX

A

Exocrine def test
Exocrine enzymes (amylase protease lipase )
🩲Low Fecal elastase (SN and SP fir pancreatic exocrine insuff )
Elastase is produced by oancreatic acinar cells.

🩲Low Serum trypsinogen

Endocrine def test:
Diabetes testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pancreatoc exocrine insufficiency mech and ttt

A

👠Pancreatic secretion stimulated by CCK (triggered by protein and fatty meal)

👠Normally pancreatic enzymes break down CCK releasing protein and limit CCk.

👠In pancreatic insuff unchecked CCK release causes pancreatic hyperstimulation.
This causes post prandial abd pain in pts of chronic pancreatitis.

Ttt :
🧣pancreatic enzyme supplements (lipase , amylase , protease ) reduce pancreatic hyperstimulation and improve nutrient digestion.
Steatorrhea and malabsorptiin also improves.
🧣Ingestion of freq small meals that are low in fat also improve pain.
🧣Ttt of pain with pregablin, nortriptyline, amitriptyline. (Non opiate analgesia prefered)
🧣 treat DM and stop alcohol and tobacco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Post ERCP pancreatitis. Dx

A

Do lipase before CT.
Lipase rises earlier in few hours.
CT remains normal upto 48hrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute pancreatitis diagnostic criteria

A

🧥Severe Epigastric Pain (radiating to back)
🧥Amylase / lipase >-3 times upper limit of normal.
🧥Characteristic findings of acute pancreatitis on imaging ( CT , MRI, USG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Post ERCP complications

A

Ascending cholangitis
Perforation
Pancreatitis

Post ERCP pancreatitis is prevalent in SOD pts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common causes of Acute Pancreatitis

A

Gall stones
Alcohol
Hypertrigkyceridemia (TG >1000)

Drug induced (less common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Severe Acute Pancreatitis def

A

Pancreatitis that causes failure of >-1 organ systems (renal , resp, cardiovascular ) lasting >48hrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Predictors of worst prognosis in SAP

A

👘AMS

👘 signs of SIRS

👘 elevated BUN >20mg/dl , Cr >1.8mg/dl and Hct >44%
Reflecting Intravascular volume depletion (with hemoconcentration) due to third spacing of fluid caused by inflammatory response and increased capillary permeability.

👘 radiologic findings of third Spacing of fkuids (pulm infiltrates or pleural effusion)
CT scan : severe pancreatic necrosis

👘old age >55 , obesity BMI >30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Systemic inflammatory Response syndrome criteria

Study These Flashcards
A

2 of the following :

Temperature >100.4 F or <36 (96.8)
Pulse >90/min
Resp >20/min or pCO2 <32 mmhg
WBCs >12,000 or <4000 or >10% bands

23
Q

Infected pancreatic Necrosis etiology

Study These Flashcards
A

Pts with signs of sepsis few days after acute nectrotizing pancreatitis.

pancreatic inflammation (pancreatitis) causes uncontrolled release of pancreatic enzymes causing autodigestion of pancreatic parenchyma and peripancreatic tissue (pancreatic edema and necrosis on CT)
Resulting Necrotic Collection is sterile
Infection with enteric bacteria (Ecoli , Psuedomonas , Enterococcus)
Occurs in a third of patient 7-10days after acute nectrotizing pancreatitis.

24
Q

Dx of infective pancretic necrosis

Study These Flashcards
A

🏣CT scan (even if initial CT was taken)

     Gas within necrotic tissue is diagnostic and prompts IV AB

🏣If CT is equivocal: aspiration and culture

25
Ttt of infected Pancreatic Necrosis
🗻IV ab 🗻Debridement if necrotic tissue (after AB so infection is walled off which facilitates debridement )
26
CF of severe pancreatitis
🪗Fever, tachycardia , hypotensions 🪗Dyspnea , tachypnea , basilar crackles 🪗Abd tenderness distension 🪗Cullen sign: periumb bluish discoloration (hemoperitoneum) 🪗Grey Turner sign: Reddish brown coloration around flanks (retroperitoneum)
27
RF for severe pancreatitis
🚨Age >75 🚨Obesity 🚨Alcoholism 🚨CRP : >150 at 48hrs after presentation 🚨Rising BUN and Cr in first 48hrs 🚨Xray : Pulm infiltrates /pleural effusion 🚨CT scan/ MRCP : Pancreatic necrosis and extra pancreatic inf
28
Complications of severe pancreatitis
Pseudocyst Peripancreatic fluid collection Necrotizing pancreatitis ARDS GI bleed
29
Acute pancreatitis complicated by hypotension
Activated pancreatic enzymes enter vascular system and inc vascular permeability within and around the pancreas. This causes large volumes of fluid migrating from vascular system to surrounding retroperitoneum. Systemic inflammation ensues as inflammatory mediators enter vascular system. Net effect is widespread vasodilation , capillary leak , shock , end organ damage. Ttt: IV fluids.
30
How soon do psudocysts form after Acute pancreatitis episode
3-4 weeks
31
Pt with negative CT scan after BAT , persistent upper abd pain , nausea , low grade fever and large upper abd fluid collection
Pancreatic duct Injury
32
Pancreatic duct injury after BAT
Leakage of inflammatory pancreatic juice causes accumulation of peripancreatic fluid BAT causes rapid compression of fixed , retroperitoneal pancreas against vertebral column SS of pancreatic duct injury 🚜 persistent abd discomfort/tenderness 🚜 persistent Nausea/emesis 🚜 increasing Amylase over serial measurements 🚜 Peripancreatic fluid collection (due to ductal injury) Ttt surgery Dx : Cholangiopancreatography
33
Dx of Acute pancreatitis
Dx requires 2 of the following : 🛞Acute epigastric pain radiating to back 🛞Amylase or lipase >3x normal limit 🛞Abnormalities on imaging consistent with pancreatitis. Others. 🛞ALT >150 suggests biliary pancreatitis 🛞Severe dx : fever , tachypnea , hypoxemia , hypotension 🥁in pts with typical Abd pain and markedly elevated amylase/lipase levels CT or imaging is not required. (CT is inaccurate in first 72 hrs as signs of impaired perfusin and necrosis take days to evolve) Hence CT ismostly done in case of diagnostic uncertainty.
34
Gall stone pancreatitis dx and ttt
Pts with pancreatitis (epigastric pain , elevated amylase /lipase) with RF for gall stones and elevated LFTs(high ALT) Dx : RT upper USG Ttt: cholecystectomy
35
Pancreatic adenocarcinoma CF
🛞Systemic Symptoms (weight loss , anorexia) 🛞Discomfort /subacute pain (abdomen , back) 🛞Jaundice 🛞Unexplained migratory superficial thrombophlebitis Think about pancreatic CA in pt of chronic pancreatitus with worsenjng abd pain and weight loss
36
Pancreatic CA labs and dx
🛞Cholestasis (Inc ALP and direct Bilirubin) 🛞Inc CA19-9 🛞Abd USG (head mass ) or CT scan (ill defined pancreatic mass)
37
Pancreatic CA head dx Ttt
P. CA head : Jaundice due to CBD obstruction Elevated ALP and bilirubin Steatorrhea (ductal blockage or exocrine insuff) Dx : USG (Also USG rules out other causes of biliary ductal obstruction eg cholidocholithiasis )
38
Pancreatic CA body and tail dx and ttt
SS : Do not present with obstructive jaundice Dx : CT with contrast Delineate necrosis within pancreas and identify distant mets and helps exclude other conditions. (USG cannot visualize body and tail due to overlying bowel gas and for small tumors <3cm)
39
Acute pancreatitis first labs to be done
Amylase and lipase. (If pt has typical pain and elevated enzymes no imaging is done) Early in pancreatitis , pancreas makes enzymes but doesnt secrete them. These leak out into systemic circulation Amyalse rises in 6-12hrs. And remains elevated 3-5 days. Lipase rises within 4-8hrs but remains elevated 8-14 days. Hence lipase is SN and more. useful
40
Acute Pancreatitis due to Hypertriglyceridemia CF and Dx
Eruptive xanthomas CF of acute pancreatitis Dx Fasting Serum TG : >1000 Family History of early MI and hyoertrigkyceridemia
41
Cause of Acute oancreatitis
🧘🏻Alcohol 🧘🏻Gall stones 🧘🏻Hypertrigkyceridemia Less common Medication: azathioprine , valproic acid , thiazide diuretics Infection : CMV ERCP Trauma
42
Pancreatic ascites cause. And CF
Pancreatic ascites results from damage to pancreatic duct with leakage of pancreatic juice in peritoneal space. CF: Pt with recurrent pancreatitis now develops abd distension Chronic pancreatitis pt. Ascitic fluid high in protein >-2.5 g/dl High in amylase >1000U/L Low SAAG ratio (<1.1 indicating non portal HTN)
43
Abdominal Compartment syndrome def
Rise in intraabd pressure reduces organ perfusion to the point of causing organ dysfunction. RF : Massive fluid resuscitation (as in acute oancreatitis ) Major intraabd surgery
44
Cardiovascular consequences of Abd Compartment syndrome ACS
🥇 inc IAP and intrathoracic pressure causes venous compression ➡️ Inc CVP (Despite reduce preload due to Extrinsic compression- uncoupled CVP and Cardiac preload. As Normally dec preload has reduced CVP ) 🥇 the extrinsic compression ➡️ dec VR to heart ➡️ dec Cardiac PRELOAD 🥇 diaphragmatic elevation compresses heart and decreases ventricukar filling. 🥇 dec Cardiac Preload and Ventricukar filling ➡️ Dec CO , hypotension , compensatory tachycardia
45
Management of Abdominal compartment syndrome
Temporizing measures : 🗻Avoid over resuscitation 🗻Dec intraabd vol (NG tube) 🗻Inc Abd wall compliance (sedation) Definitive ttt: Surgical decompression
46
Why doesnt abdomen accomodate fluids in ACS as it does in ascites
Abd wall compliance doesnt increase in acute setting so small volume of rapidly accumulating intraabd fluid can markedly increase IAP and cause ACS. In ascites progressive abd wall stretching over time (weeks) greatly increase abd wall compliance allowing large fluid volumes (>15L) to accumulate without ACS.
47
Pancreatic pseudocyst Pathophys and dx
Mature walled off pancreatic fluid collection (no necrosis or solid material ) surrounded by thick fibrous capsule and contains enzyme rich fluid , tissue and debris. Can leak amylase rich fluid into circulation and inc serum amylase. Dx: CT with contrast
48
Complications of pseudocyst
Spontaneous infection Duodenal /biliary obs Pseudoaneurysm (digestion of adj vessels) Pancreatic ascites Pleural effusion
49
Ttt of Pseudocyst
Minimal to no symtoms no complications; NPO , conservative ttt Sig symptoms/infection: Endoscopic drainage Psudoaneurysm: Embolization then endoscopic drainage
50
Acute pancreatitis after cardiac catheterization/vascular procedure
Consequences of cholesterol emboli 🦷Skin : Livedo reticularis (reticulate , mottled , discolored skin ) blue toe syndrome 🦷Kidney : Acute kidney injury 🦷GIT : Pancreatitis , mesenteric ischemia
51
Ttt of acute pancreatitis due to ischemia/atherosclerosis (cholesterol emboli after cardiac cath)
Analgesics and IV fluids
52
How to manage gall stone pancreatitis
👗If patient has ascending cholangitis or Confirm Biliary obs(CBD dilation plus stone) ⬇️ Urgent ERCP ⬇️ Once pancretitis has resolved do Cholecystectomy 👗If no ascending Cholangitis Possible biliary Obstruction (persistent Inc LFTs , CBD dilation) ⬇️ EUS/MRCP followed by ERCP If bile stone visualized ⬇️ Cholecystectomy once Pancreatitis has resolved 👗No ascending cholangitis No biliary obs ⬇️ Supportive Care (IV fluids , analgesics) ⬇️ Chole when pancreatitis has resolved
53
Indication of ERCP in pancreatitis
CBDobstruction. (Dilated CBD containing stone on USG) Evidence of acute cholangitis (Fever RUQ abd pain , jaundice , hypotension , confusion)
54
Common drugs to cause Acute pancreatitis
🐦Diuretics (furosemide , thiazides) 🐦IBD drugs (sulfasalazine , 5-ASA) 🐦Immunosuppressive (azathioprine) 🐦HIV related medications (didanosine, pentamidine) 🐦Antibiotics (metronidazole , tetracycline) 🥾Drug induced pancreatitis is mild

GIT (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions