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):
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

31

celiac artery

spleen and stomach

32

35yo M 3 bouts of pancreatitis, epigastric pain, weight loss, bulky stools 5 weeks
-glucose 250

chronic pancreatitis - on X-ray - expect to see calcified pancreas

33

calcification, pain, steatorrhea, osmotic diarrhea, weight loss, vit deficiency, diabetes, epigastric pain

chronic pancreatitis

34

diagnosis of chronic pancreatitis

-Xray - calcification
-US/CT - ductal dilation
-ERCP - most sensitive and specific**
-MRI - with cholangiopancreatography

35

secretin/CCK secretion test

for chronic pancreatitis

36

24 hour fecal fat

test for chronic pancreatitis

37

pancreatic vs. intestinal steatorrhea

pancreatic - secretin test, fecal elastase tests

intestine - D-xylose, schilling test

38

d-xylose test

less than 4g of 25g d-xylose measured in urine over 5 hours
-mucosal malabsorption or bacterial overgrowth

pancreatic - d-xylose is not effected - so urine has adequate d-xylose

39

tx chronic pancreatitis

-drug for pain
low fat diet
-lipase with meals with H2 blocker
-watch for cancer

40

pt over 50yo who develops diabetes no risk fx

look for chronic pancreatitis

41

pneumatosis intestinalis

air in bowel wall
-can be benign or life-threatening

benign - COPD, scleroderma, crohns, corticosteroids

life-threatening - mesenteric vascular ischemia

42

LUQ pain and splenomegaly, low RBC, platelets, WBC

peripheral smear - lymphos with hair-like projections

hairy cell leukemia - subgroup of chronic lymphocytic leukemia (CLL)

main markers - big spleen**

43

hairy cell leukemia

malignant immature B cells

44

periumbilical pain, rash, stridor, diffuse cramps
-following fall at work
-two prior episodes of edema, feet, labia 3 days after horseback riding

-chicken wire loops on back
-CT - edema of bowel wall

trauma - activation of complement pathway

C1 esterase deficiency**

45

chicken wire loops

urticarial rash and edema with swelling

C1 esterase deficiency

46

bradykinin

can cause edema

coag system can stimulate its release

47

C4 with low C1 in acquired angioedema and normal C1 in HAE

chicken wire appearance

HAE - prodrome rash

C1 esterase deficiency

48

23yo F diffuse abdominal pain, constipation, 2 months

-hyponatremia
-fad diet - last 6 months
-depression
-numbness of left arm and right leg
-pupils dilated and HR rapid

acute intermittant porphyria
-deficiency of phophobilinogen deaminase

"porphyria"

49

16yo M fever and diffuse abdominal pain, appendectomy one year ago, pleural rub over right posterior chest, tender scrotum, ankle rash, WBC and sed rate increased

familial mediterrean fever

50

familial mediterrean fever

IL-8 disease - overactive

chronic - amyloid** - acute phase reactant

WBC mobbing tissue spaces - pathergy

51

amyloid production

familial mediterranean fever

die from kidney failure

52

45yo black M RUQ pain
-tender and pedal edema

CXR - cardiomyopathy
EKG - hypercalcemia

hypercalcemia, sarcoidosis**
-restrictive cardiomyopathy

-high pulmonary pressures - with restrictive cardiomyopathy - can lead to liver congestion