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Flashcards in 73. Acute pancreatitis Deck (18):
1

acute pancreatitis

autodigestion of pancreas by pancreatic enzymes ( premature activation of trypsin)

2

causes of acute pancreatitis

mnemonic : I GET SMASHED and RUpture of posterio
duodenum ulcer
idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Hypercalcemia, Hypertriglyceridemia ( >1000 mg /dL)
ERCP
Drugs ( sulfa, NRTIs, portease inhibitors )

3

acute pancreatitis - diagnosis

2 of 3 criteria
1. acute gastric pain ( often radiating to the back )
2. high serum amylase or lipase ( more specific ) to 3x upper limit of normal
3. characteristic imaging findings

4

acute pancreatitis - complication

1. pseudocysts
2. necrosis
3. hemorrhage --> shock
4. infection ( or abscess)
5. organ failure ( ARDS, shock, renal failure)
6. hypocalcemia ( precipitation of Ca2+ soaps )
7. DIC

5

pancreatic pseudocyst- formed by/ findings

- formed by lined by granulation tissue, not epthelium, and pancreatic enzymes
- abdominal mass with persistently elevated serum amylase

6

pancreatic pseudocyst risk for

rupture--> enzymes in the abnominal cavity and hemorrhage

7

pancreatic abscess - due to, presents with

due to E. Coli
presents with abdominal pain, high fever, persistently elevated amylase

8

special clinical presentation in necrotic pancreatitis

periublical ( Cullen;s sign) and flank ( Grey turner ) hemorrhage

9

• Define the pathophysiology of acute pancreatitis.

Pancreatic enzymes become activated, leading to autodigestion of the pancreas

10

• List five causes of acute pancreatitis.

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmunity, Scorpions, Hypercalcemia/triglyceridemia, ERCP, Drugs (sulfa) (GET SMASHED)

11

• You become concerned for acute pancreatitis when an alcoholic man complains of severe abdominal pain that radiates where?

Epigastric pain that radiates to the back

12

• A patient has acute epigastric pain radiating to the back. What two values will be elevated, characterizing his disorder?

Amylase and lipase levels will likely be elevated (the patient has acute pancreatitis)

13

• Which has higher specificity for acute pancreatitis: amylase or lipase?

Lipase (amylase can be elevated in other disorders such as mumps)

14

• A 67-year-old woman is admitted with acute pancreatitis. For what major complications should you be vigilant?

DIC, ARDS, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage, infection, multisystem organ failure

15

• How does acute pancreatitis lead to hypocalcemia?

Ca2+ collects in pancreatic soap deposits, causing hypocalcemia

16

• A man has a CT done for persistent pain after acute pancreatitis. The pathologic structures (arrows in image) are lined by what tissue type?

Granulation tissue (these are pancreatic pseudocysts)

17

• A man with nausea and epigastric abdominal pain radiating to the back asks about major complications from his illness. What do you tell him?

Pancreatic pseudocysts (if he has them) can rupture and hemorrhage

18

• Laparotomy of a patient with abdominal pain reveals chalky white deposits. What are some causes of this condition?

Causes include gallstones, ethanol, trauma, steroids, mumps, autoimmune disease (remember GET SMAshed) (this is acute pancreatitis)

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