Abdominal Pain and Pancreatic DIsease CIS - Darrow Flashcards Preview

Year2 GI Exam II > Abdominal Pain and Pancreatic DIsease CIS - Darrow > Flashcards

Flashcards in Abdominal Pain and Pancreatic DIsease CIS - Darrow Deck (52)
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1

62yo F obese diabetic acute epigastric pain
-alcohol
-elevated amylase and lipase
-WBC elevated
-AST/ALT elevated

most likely cause of pancreatitis?

next day - BUN increased and C-RP is elevated, drop in hemoglobin, creatinine elevated
-abdominal bruising

-pt improves -but 6 weeks later - pseudocyst

pancreatitis

-follow the BUN

2

acute pancreatitis

need 2 of 3 criteria

-epigastric pain to back
-amylase or lipase > 3x normal
-characteristic finding on CT

3

obesity and pancreatic disease

bad
-central obesity - metabolically active organ

local circulatory changes in peripancreatic fat and produces hypoxia by limiting respiration

BMI > 30 poor prognosis

4

elevated amylase

non-specific

-macroamylasemia** - amylase too big to get through kidn
ey
-bowel problems
-ectopic production
-renal insufficiency
-trauma

5

labs for pancreatitis

best test - lipase

amylase is non-specific

ALT >150 suggest biliary pancreatitis

urine for trypsinogen activation peptie (TAP)

6

ALT > 150

suggest gallstones as pancreatitis cause

7

causes of acute pancreatitis

gallstones
alcohol
idiopathic
drugs, genetic, metabolic, vascular, autoimmune

8

IgG4

autoimmune
acute pancreatitis

9

genetic pancreatitis

can give predisposition

CASR, PRSS1, SPINK1 mutations

10

cullens sign

blood around umbilicus

11

grey turner sign

blood around flanks

12

intraperitoneal bleeding

cullens sign
grey turner sign

can occur in hemorrhagic pancreatitis

13

ranson criteria

predict severity of pancreatitis

above 3 - bad

age, WBC, glucose, LDH, AST

at 48 hours repeat - includes BUN and other criteria

14

APACHE II

score above 8 - bad - necrosis

used to assess severity of pancreatitis

rectal temp, MAP, HR, RR, FiO2, arterial pH, Na, K, Cr, Hct, WBC

15

HAPS score

harmless acute pancreatitis score

-absence of rebound tenderness
-normal hemacrit, normal creatine
-better prognosis

predicts non-severe course

16

SIRS

high pulse
high respirations
high WBC

can occur in pancreatitis
-toward shock

systemic immune response syndrome

17

BISAP-B score

BUN, impaired mentality, SIRS, age >60, pleural effusion

3 or more - bad sign

with pancreatitis

18

C-RP

>150 - pancreatic necrosis

19

Cr

>1.8 - necrosis

20

hemacrit

>44% - necrosis

21

clinical presentation for acute pancreatitis

epigastric pain to back
mid abdominal staining - bruising (cullens and grey turners)
-yellow - jaundice
-lipase
-left sided pleural effusion
-amylase
-sentinel loop and colon cut off signs
-emesis and nausea

22

epigastric pain to back
mid abdominal staining - bruising (cullens and grey turners)
-yellow - jaundice
-lipase
-left sided pleural effusion
-amylase
-sentinel loop and colon cut off signs
-emesis and nausea

acute pancreatitis

lipase - best test

23

CT severity index

to determine prognosis of patient with pancreatitis

24

first test for suspected gall stone pancreatitis

US

25

dark on CT

pancreatic necrosis

26

necrotizing pancreatitis

50% change of infection that can become abscess and 30% chance of mortality

27

complications of acute pancreatitis

ransom > 3
apache > 8

multiple organ dysfunction - BP < 90, pO2 < 60, Cr > 2, GI bleed

systemic - DIC, hypocalcemia

ascites, pseudocyst, chronic pancreatitis

28

hypocalcemia

complication of acute pancreatitis - bad thing - indicates more saponification

29

tx of pancreatitis

-apply criteria
-fine needle aspiration and drain
-ERCP

-evidence of progression - enteral formula through feeding tube below ligament of trietz

30

antibiotics for pancreatitis

imipenem