Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Year II repeat > pancreatitis > Flashcards

pancreatitis Flashcards

1
Q

rfs and pfs for acute pancreatitis

A
  • RFs
    • Smoking
    • High dietary glycemic load Abdominal adiposity
    • ↑ Age and obesity
      • Increases changes of more severe course
  • PFs
    • high vegetable/fiber diet
    • statins (bar simvastatin which increases it)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Assessment of Severity

A
  • Ranson Criteria
  • Sequential Organ Failure Assessment (SOFA)
  • Modified Marshall scoring system
  • APACHE II
  • Bedside Index for Severity in Acute Pancreatitis (BISAP)
  • Presence of SIRS (Systemic Inflammatory Response Syndrome) and Elevated BUN on admission with a rise in BUN w/in first 24 hours of hospitalization
  • Early rise in serum levels of neutrophil gelatinase-associated lipocalin has been proposed as a marker of severe acute pancreatitis
  • HAPS (“Harmless acute pancreatitis score”)
  • Revised Atlanta classification (Mild, Moderate, Severe)
  • CT Grade of Severity Index for Acute Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ranson criteria and apache II score

A

ranson: 1-2 (1% mortality); 3-4 (16% m); 5-6 (40%); 7-8 (100%)

physiological score + age + chronic health points = APACHE II score

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

RISK Factors for Severe Acute Pancreatitis with high levels of fluid accumulation

A

 Younger age

 Alcohol etiology

 Higher hematocrit value

 Higher serum glucose w/in 48 hrs of hospital admission

 SIRS w/in 48 hrs of hospital admission

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

which criteria predicts a severe course complicated by necrosis, and what value corresponds to this in the criteria?

A

3 or more aspects of the criteria, ranson criteria, 60-80 sensitivity

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

Revised Atlanta Criteria

A

mild AP: no oran failure, no complications

moderate AP: transient organ failure < 48 hrs with +/- complications

severe: organ failure lasting longer than 48 hrs +

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

Tx of Mild Acute Pancreatitis

A

80% resolve without complications

Lots of fluids: 1/3 of a 72 hr fluid administration needs to be delivered to the patient in the first 24 hours of their presentation.

Let the pancreas rest: NPO, bed rest, NG suction for the ileus

Fluid administration prevents SIRS (systemic inflammatory response syndrome) but may induce ARDS (acute respiratory distress)

opioids for pain; when pain relieved, begin oral administration of food/liq

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

tx of severe pancreatitis

A

FFP for coagulopathy

Serum Albumin infusions to restore albumin

calcium glucoronate for hypocalcemia with tetany

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

I GET SMASHED

A

Idiopathic

Gallstone obstruction

Ethanol abuse

Trauma

Steroid abuse

Mumps

Autoimmune disorders

Scorpoion sting

Endoscopic Retrograde Colangiopancreatography (ERCP)

Hypertriglyceridemia/Hypercalcemia

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

SAPE

A

sentinel Acute Pancreatitis Event

hypothesis that a single initiating event damages the pancreas and leads to later chronic pancreatitis via necrosis-fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Labs for acute pancreatitis

A

increased serum amylase and lipase: normal doesnt exclude diagonosis

increased total bilirubin (direct) and alkaline phosphatase (if pancreas is compressing the bile duct): normal does not exclude diagnosis

vitamin deficiencies but uncomplicated (too fast)

glycosuria

autoimmune condition pancreatitis: IgG4/ANC/Ab-carbonic anhydrase II and lactoferrin/

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

Shows lymphoplasmacytic inflammatory infiltrate with characteristic IgG4 immunostaining

A

Autoimmune pancreatitis

Elevated IgG4

Elevated ANA

Ab to lactoferrin and carbonic anhydrase II

Pancreatic biopsy

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

Panceatic function tests

A
  • Trypsinogen
    • level is low in insufficiency (<20 ng/ml) causes steatorrhea
  • Fecal elastase
    • low in insufficiency (<100 mcg/gram stool)
  • Pancreatic malabsorption
    • when enzyme secretion is <5-10% takes >5 years
  • Stimulation tests
    • Cholecystokinin/secretin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Imaging in Pancreatitis

A

X-ray: calcifications

CT: more detailed calcifications, plus ductal dilations, atrophy or heterogeneity of the gland. “tumfactive chronic pancreatitis”- concern for pancreatic cancer

ERCP: most detailed for calcifications, ductal dilations, stones, strictures, pseudocyst. Rarely used alone for diagnosis. Results may be normal with minimal change chronic pancreatitis.

MRCP:
Can enhance imaging with secretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. diffuse enlargement of the pancreas, a peripheral rim of hypoattenuation, and irregular narrowing of the main PD (autoimmune)
  2. Lobularity with honey-combing of pancreatic parenchyma
  3. Hyperechoic foci with shadowing indicative of calculi in main pancreatic duct (PD)

the three components of the “Rosemont criteria” observed with EUS

A
17
Q

complications of acute pancreatitis

A
  • Opioid addiction
  • Brittle diabetes mellitus
  • Pancreatic pseudocyst or abscess
  • Cholestatic liver enzymes +/- jaundice Bile duct stricture
  • Pancreatic insufficiency
    • Steatorrhea
    • Malnutrition Osteoporosis
  • Peptic ulcer
  • Pancreatic CA
    • 4% after 20 years
    • ↑ to 19% by age 70
18
Q

Pancreatic insufficiency

A
  • Exocrine
    • Confirmed by response to therapy with pancreatic enzyme supplements
    • Secretin stimulation test
    • Detection of decreased fecal chymotrypsin
    • Decreased Pancreatic fecal elastase (<100mcg/gram)
    • 40% have B12 malabsorption detected through labs
      • Don’t see it as clinical deficiency though
      • Don’t see clinical deficiency of fat soluble vitamins either
  • Endocrine
    • 80% develop DM after 25 years of chronic pancreatitis
19
Q

complications of pancreatic insufficiency

A
  • Low fat diet
  • Alcohol is forbidden
    • Precipitates attacks Avoid opioids if possible
  • Use acetaminophen, NSAIDs, tramadol, + tricyclic antidepressants, SSRIs, gabapentin or pregabalin
  • Steatorrhea
    • Pancreatic supplements with high lipase activity
    • Use H2 blocker, PPI, or sodium bicarb
  • Patient’s with CF Chronic Pancreatitis
    • High dose pancreatic enzyme therapy has been associated with strictures of the ascending colon
  • Treat associated diabetes mellitus
  • Autoimmune Chronic Pancreatitis
    • Corticosteroids, taper after a few months
    • Rituximab or azathioprine if having no response or relapse with corticosteroids
  • Endoscopic or surgical therapy (stent, dilation, lithotripsy, surgical drainage or resection)
    • if biliary tract disease ensure free flow of bile, drain pseudocysts, treat other complications, eliminate obstruction of PD, relieve pain, exclude pancreatic CA
20
Q

cystif fibrosis and pancreatitis

A

pancreatic insufficiency is the most common effect of CF on children.

newborns with CFTR mutation often suffer meconium ileus

21
Q

pancreatic insufficiency: complications and mortality issues

A
  • Chronic pain
  • Often leads to disability and reduced life expectancy
  • Pancreatic CA is main cause of death
  • Better in patients with etiology from a remediable condition or autoimmune hepatitis.
22
Q

MEN Type 1

A
  • Two or more of the following:
    • Parathyroid
      • Hypercalcemia, ↑intact PTH
    • Pancreas
      • Gastrinoma aka Zollinger Ellison
        • MC in duodenum, then pancreas
        • Insulinoma- hypoglycemia
    • Pituitary
      • (possible, acromegaly, Cushing)
    • Thyroid (less often)
    • Adrenal (less often)
    • Carcinoid (Rare)
23
Q

MEN Type 2A

A
  • Two or Three of the following:
    • Thyroid (Medullary Thyroid CA)
      • Elevated calcitonin ( low calcium)
    • Adrenal (Pheochromocytoma)
      • Elevated catecholamines
    • Parathyroid
      • Hypercalcemia, ↑intact PTH
      • These patient’s may have normal Ca due to thyroid and parathyroid canceling each other out.
  • Two to five percent will develop Hirschsprung disease
24
Q

MEN Type 2B

A
  • MEN Type 2B
  • Marfanoid body habitus Medullary thyroid cancer
  • Elevated calcitonin Pheochromocytomas
  • Elevated catecholamines Neuromas
  • Occur on lips, tongue, mouth, eyelids, etx. Frequently a new gene mutation
  • No family history
25
Q
A

GI Year II repeat (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions