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Acute Pancreatitis Flashcards

(38 cards)

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1
Q

What does the pancreas do?

A
  1. neutralizes acidic chyme (secretes 1.5-3L of alkaline fluid daily
  2. digestion of proteins (trypsin, chymotrypsin) and fats (amylase, lipase)
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2
Q

How does the pancreas manage glucose levels?

A

releases insulin when blood glucose is too high;
releases glucagon when blood glucose is too low

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3
Q

How does the pancreas manage hormones?

A
  1. secretin stimulates ductal cells to secrete bicarb-rich fluid
  2. cholecystokinin (CCK) stimulates acinar cells to secrete digestive enzymes
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4
Q

What type of neural control does the pancreas have?

A

autonomic innervation (parasympathetic and sympathetic nerve fibers)

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5
Q

What enzymes are increased with inflammation and have a non-specific pathology?

A

Amylase
Lipase

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6
Q

Why is an x-ray the initial test for acute pancreatitis?

A

pancreas looks abnormal in acute and chronic pancreatitis

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7
Q

What can an ultrasound of the pancreas show?

A
  1. edema
  2. inflammation
  3. calcification
  4. masses
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8
Q

What can a CT scan with contrast show?

A

visualizes necrosis and fluid collections

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9
Q

What can an MRCP show?

A

3-D view of necrosis and fluid collections
(best imaging)

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10
Q

What is the difference between acute and chronic pancreatitis?

A

acute- inflammation
chronic- fibrosis

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11
Q

What is the cause of acute pancreatitis?

A
  1. autodigestion (unregulated activation of trypsin)
  2. inflammation (activated complement and kinin pathways)
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12
Q

What is the most common cause of acute pancreatitis?

A

Obstruction
1. Gallstones
2. duodenal obstruction
3. chron’s

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13
Q

What toxins can cause acute pancreatitis?

A
  1. alcohol
  2. medications
  3. scorpion bite
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14
Q

Why does obstruction cause pancreatitis?

A

increased ductal pressure leads to the activation of pancreatic enzymes

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15
Q

What antibiotic can cause biliary sludging?

A

Ceftriaxone

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16
Q

What is the number 1 cause of toxic pancreatitis?

17
Q

What drugs can induce acute pancreatitis?

Study These Flashcards
A
  1. statins (rosuvastatin)
  2. ACE (-)
  3. oral contraceptives
  4. Diuretics (loop)
  5. HIV HAART therapy
  6. Valproic acid
18
Q

What are other causes of acute pancreatitis?

Study These Flashcards
A
  1. infections
  2. triglyceridemia >500
  3. autoimmune
  4. pregnancy
19
Q

How does pain present in acute pancreatitis?

Study These Flashcards
A

constant in the epigastric area and right upper quadrant; can radiate to the back; lasts days

20
Q

What are the symptoms of acute pancreatitis?

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A

nausea
emesis
fever
tachycardia
leukocytosis
hypocalcemia
hyperglycemia

21
Q

What is a bruise that shows pancreatic necrosis into the retroperitoneum?

Study These Flashcards
A

cullen’s sign

22
Q

What is required for diagnosis?

Study These Flashcards
A

2/3 required:
1. abdominal pain
2. 3x elevation in serum amylase/ lipase
3. CT scan showing inflammation

23
Q

When should treatment of infection begin?

Study These Flashcards
A

If CT scan shows “walled off area”/ puss pocket near necrotic tissue

24
Q

How is mild acute pancreatitis classified?

Study These Flashcards
A
  1. organ failure absent
  2. local and systemic complications absent
  3. Hct > 44%
25
How is moderate acute pancreatitis classified?
1. organ failure transient <48 h 2. local/ systemic symptoms present 3. BUN >22
26
How is severe acute pancreatitis classified?
1. organ failure persistent >48h 2. local/systemic symptoms present 3. signs of organ failure (BP <90, HR >130, SCr 1.5x baseline)
27
How are mild and moderate acute pancreatitis managed?
1. fluid resuscitation 2. NPO until tolerated 3. pain management 4. anti-emetic therapies
28
How is severe acute pancreatitis managed?
1. fluid resuscitation 2. enteral feeding 3. management of necrosis
29
What agent is preferred for fluid resuscitation?
Lactated ringers or normal saline 5-10 ml/kg/hr
30
What is the goal of fluid resuscitation?
reduce HR <120
31
What agents are initially used for pain management?
opioids + stimulant laxatives
32
What issues can occur when a patient is NPO?
1. increased intestinal mucosal atrophy 2. infectious complications due to bacterial translocation in the gut
33
How long will someone with severe acute pancreatitis get nutrition through nasoenteric feeding?
24-48 hours
34
How long should nutrition be withheld in mild pancreatitis?
within 48 hours until patient can tolerate oral intake; restart gradually
35
Is antibiotic prophylaxis recommended to prevent infectious pancreatitis?
No
36
What bacteria are potential causes of infection?
GM-: E.coli, Kleb, pneumonia, pseudamonis. proteus mirabilis GM+: enterococcus, streptococcus
37
What is the empiric treatment for pancreatic infection?
Imipenem or Meropenem for 14 days
38
How are future flares prevented?
1. avoid alcohol 2. maintain triglyceride level 3. change to medications with less incidence of pancreatitis 4. avoid trigger foods

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