Acute Pancreatitis

Question 1

Most common causes

Answer 1

Gallstones
Alcohol

امجا
Smoking
ERCP

Question 2

What reduces pancreatitis after ERCP?

Answer 2

Use of a prophylactic pancreatic duct stent
rectal NSAIDs
rectal indomethacin

Question 3

Risk factor of age

Answer 3

پیر نه بوون خطره🥸🥸🥸🥸🥸🥸

Question 4

Trypsin is activated by

Answer 4

Endotoxins, Exotoxins,
Viral infections,
Ischemia,
oxidative stress,
lysosomal calcium,
direct trauma
Spontaneous activation

Question 5

Activated trypsin can lead to activation of

Answer 5

Elastase
Phospholipase A2

Question 6

is the major symptom of acute pancreatitis.

Answer 6

Abdominal pain

is located in the epigastrium and periumbilical region, and may radiate to the back, chest, flanks, and lower abdomen.
Nausea, vomiting, and abdominal distention due to gastric and intestinal hypomotility

Question 7

Acute pancreatitis can lead to

Answer 7

Tachycardia
Hypotension
Shock
Cullen’s sign (around umbilicus) +Grey turner’s sign(around flanks) turn around😜
Jaundice occurs infrequently
Erythematous skin nodule
pulmonary findings
Leukocytosis
Increase in hematocrits
prerenal azotemia with a blood urea nitrogen (BUN) level >22
ALk and AST levels transiently elevated, and they parallel serum bilirubin values and may point to gallbladder-related disease or inflammation in the pancreatic head.

Hyperbilirubinemia 4-7d/transient jaundice

Hypoxemia (arterial PO2 ≤60 mm Hg), which may herald the onset of ARDS.
Abnormal electrocariogram /myocardial ischemia
Hypocalcemia
Hyperglycemia

Question 8

clinch the diagnosis if gut perforation, ischemia, and infarction are excluded.

Answer 8

Raised level of Amylase .

Question 9

Lipase more specific than amylase

Answer 9

أميلاز دواي حفتةيگ لة خوةيةو عدلةو بوود .☹️
اميلاز لة تشتةيل تريش چدة بان☹️
اوانةي pHخوينيان كةمةو بوود ،اميلاز بصورة كاذبة چدة بان ☹️
اوانةي دهون ثلاثيان بةرزة ، بصورة كاذبة اميلازيان طبيعية☹️
اميلاز لة acute cholecystitis يش چدة بان ☹️

Question 10

Diagnosis

Answer 10

زگژان ،تحليلةگان ، imaging

Question 11

Is the most important clinical finding in regard to severity of the acute pancreatitis episode.

Answer 11

Persistent organ failure (>48 h)
form one of these three organ systems(respiratory, cardiovascular, and renal) using the modified Marshall scoring system

🥶🥶🥶🥶🥶🥶🥶🥶If SIRS is not present at 24 h, the patient is unlikely to develop organ failure or necrosis. 🥶🥶🥶🥶🥶🥶🥶🫡🫡🫡🫡🫡🫡🫡🫡

Question 12

………………is characterized by a protracted course of illness and may require imaging to evaluate for local complications.

Answer 12

The late phase

Question 13

Mild acute pancreatitis 85-90%

Answer 13

without local complications or organ failure.

No necrosis

Most patients with interstitial acute pancreatitis have mild pancreatitis.

self-limited and subsides spontaneously, usually within 3–7 days after treatment is instituted.

Oral intake can be resumed if the patient is hungry.

Question 14

Moderate acute pancreatitis

Answer 14

transient organ failure (resolves in <48 h) or local or systemic complications

may or may not have necrosis

Question 15

Sever acute pancreatitis

Answer 15

persistent organ failure (>48 h)/ (single or multiple. )
A CT scan or (MRI) should be obtained to assess for necrosis and/or complications.

Question 16

patients with………………. are at greatest risk of mortality

Answer 16

infected/sterile necrosis

🥶🥶🥶🥶🥶🥶🥶🥶🥶If SIRS is not present at 24 h, the patient is unlikely to develop organ failure or necrosis. 🥶🥶🥶🥶🥶🥶🥶🫡🫡🫡🫡🫡🫡🫡

Question 17

The median prevalence of organ failure

Answer 17

Is higher in necrotising pancreatitis
And higher in infected one

Question 18

CT imaging

Answer 18

Recommended 3-5d from admissions to assess necrosis and local complications ,if not responding to supportive care

Question 19

Local complications such as fluid buildup

Answer 19

requires a prolonged hospitalization >1 week.

Question 20

Two types of pancreatitis are recognized on imaging as interstitial or necrotizing

Answer 20

based on pancreatic perfusion.

Question 21

Acute pancreatitis management/therapy

Answer 21

1/The most important treatment is, aggressive IV fluid resuscitation. (lactated Ringer’s or normal saline)

2/The patient is made NPO to rest the pancreas and is given intravenous narcotic analgesics and supplemental oxygen ,as needed.

3/A rise in hematocrit or BUN during serial measurement should be treated with a repeat volume challenge bollus.

4/If the BUN or hematocrit fails to respond to this bolus challenge and increase in fluid rate, consideration of transfer to ICU

Question 22

Monitoring response to therapy is by

Answer 22

measurement of hematocrit and BUN every 8–12 h

(A rising BUN during hospitalization is associated with
1/inadequate hydration
2/higher in-hospital mortality.)

Question 23

Bedside Index of Severity in Acute Pancreatitis (BISAP)

Answer 23

Five clinical and laboratory parameters obtained within the first 24 h

Patients with higher BISAP scores and elevations in hematocrit and admission BUN that do not respond to initial fluid resuscitation should transfered to ICU

Question 24

Special Considerations for ((GALLSTONE PANCREATITIS))

Answer 24

1/(rising white blood cell count, increasing liver enzymes) should undergo ERCP.

2/ and consideration should be given to performing a cholecystectomy during the same admission in mild acute pancreatitis.

3/An alternative for patients who are not surgical candidates would be to perform an endoscopic biliary sphincterotomy before discharge.

Question 25

Nutritional therapy

Answer 25

1/A low-fat solid diet can be administered to subjects with mild acute pancreatitis after the abdominal pain has resolved.(hungry)

2/Enteral nutrition instead of TPN in more severe pancreatitis.

Question 26

AB in necrotising pancreatitis

Answer 26

1/Not recommended (Prophylactic antibiotics do not lead to improved survival and may promote the development of opportunistic fungal infections)

2/Empiric antibiotics should be considered in those with clinical decompensation.

3/ if infection confirmed/give AB

Question 27

Pseudocyst
Less than 10%

Answer 27

persistent fluid collections after 6 weeks

Question 28

PERIVASCULAR COMPLICATIONS

Answer 28

splenic vein thrombosis
gastric varices
pseudoaneu-rysms.

Question 29

Secretin
CCK

Answer 29

Acidic chyme —S cells —secretin—pancrease
FA +proein —I cells —CCK—pancrease + gallbladder