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GI Exam 2 > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

(65 cards)

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1
Q

How much alkaline fluid does the pancreas secrete?

A

1.5-3 L

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2
Q

What does the pancreas neutralize?

A

Acidic chyme

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3
Q

What are the 2 pancreatic enzymes? (Protein)

A
  1. Trypsin
  2. Chymotrypsin
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4
Q

What are the 2 pancreatic enzymes? (Lipids)

A
  1. Amylase
  2. Lipase
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5
Q

What does the pancreas do for glucose management?

A
  1. Insulin
  2. Glucagon
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6
Q

What does the pancreas release? 2 (hormonal)

A
  1. Secretin
  2. Cholecystokinin
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7
Q

What does secretin stimulate?

A

Ductal cells to secrete bicarbonate-rich fluid

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8
Q

what does CCK stimulate?

A

Acinar cells to secrete digestive enzymes

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9
Q

What is the most nervative organ other than the brain?

A

The pancreas

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10
Q

What laboratory marker is increased with inflammation and is non-specific?

A

Amylase

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11
Q

What laboratory marker is increased with inflammation and is more specific?

A

Lipase

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12
Q

What is the initial test used for diagnosis of pancreatitis?

A

X-ray

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13
Q

What diagnostic test focuses on edema, inflammation, and calcification and masses?

A

Ultrasound

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14
Q

What diagnostic test is able to visualize necrosis and fluid collections?

A

CT Scan with contrast

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15
Q

What is the gold standard test to diagnose diagnosis?

A

CT Scan with contrast

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16
Q

What diagnostic test has the best imaging?

A

Magnetic resonance chloangiopacreatography (MRCP)

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17
Q

What does acute pancreatitis lead to?

A

Inflammation

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18
Q

What does chronic pancreatitis lead to?

A

Fibrosis

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19
Q

There is a low mortality in pancreatitis unless it’s what type of pancreatitis?

A

Infectious pancreatitis

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20
Q

Unregulated activation of trypsin from trypsinogen

A

Auto digestion

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21
Q

What activates the complement and kinin pathways?

A

Inflammation

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22
Q

What should you check for when inflammation arises with pancreatitis?

A

Tuberculosis reactivation

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23
Q

What is the #1 cause of obstructive pancreatitis?

A

Gallstones

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24
Q

What are three causes of obstructive pancreatitis?

A
  1. Gallstones
  2. Duodenal obstruction
  3. Crohn’s disease
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25
What are 3 direct toxicities that could lead to pancreatitis?
1. Alcohol 2. Medications 3. Scorpion bite
26
Increased ductal pressure leading to the activation of pancreatic enzymes
Obstructive pancreatitis
27
What is obstructive pancreatitis often accompanied by?
LFT elevation
28
What patient population is biliary sludging common in?
Pediatrics
29
What 4 disease states can cause obstructive pancreatitis?
1. Gallstones 2. Biliary sludging 3. Tumors 4. Crohns Disease
30
What is another cause of toxic pancreatitis?
Insecticide exposure
31
What 5 drugs can cause pancreatitis?
1. Statins 2. Oral contraceptives 3. HAART therapy 4. Valproic acid 5. ACE Inhibitors
32
What metabolic complication can cause pancreatitis?
Hyperlipidemia
33
What are 4 other causes of pancreatitis?
1. Infections 2. Metabolic 3. Autoimmune 4. Pregnancy
34
Where and how does pain present in pancreatitis? 3
1. Epigastric area and the right upper quadrant 2. Often radiating to the back 3. Often severe and lasts for days
35
What are 4 frequent symptoms from the pain experienced from pancreatitis?
1. Nausea 2. Emesis 3. Fever 4. Tachycardia
36
What are 3 severe symptoms caused by the pain in pancreatitis?
1. Leukocytosis 2. Hypocalcemia 3. Hyperglycemia
37
Pancreatic necrosis into the retroperitoneum
Cullen’s sign
38
What are 3 of the things that need to be required for diagnosis? (Only 2 out of the 3 needed)
1. Typical abdominal pain 2. Three fold or greater elevation in serum amylase and/or lipase 3. CT Scan showing inflammation of the pancreas
39
What’s the classification?: Organ failure is **Absent**
Mild
40
What’s the classification?: Organ failure is **Transient** <48 hours
Moderate
41
What’s the classification?: Organ failure is Persistent <48 hours
Severe
42
What’s the classification?: Local and Systemic complications are Absent
Mild
43
What’s the classification?: Local or Systemic complications are present
Moderate or Severe
44
What can local or systemic complications lead to?
Necrosis and elevated WBC
45
What marker of severity is associated with mild acute pancreatitis?
Hemo-concentration (Hct >44)
46
What marker of severity is associated with moderate pancreatitis?
Azotemia
47
What marker of severity is a sign of severe pancreatitis?
Signs of organ failure
48
When should you begin treatment if infection is identified?
If CT shows “walled off area” near necrotic tissue
49
What 3 things are used to treat mild to moderate disease?
1. Fluid resuscitation 2. Hold nutrition until able to tolerate 3. Pain management and anti-emetic therapies
50
What 3 things are used for severe disease management?
1. Fluid resuscitation 2. Enteral feeding 3. Management of necrosis
51
What 2 fluids can be used for fluid resuscitation?
1. Lactated ringers (best) 2. Normal saline
52
What is the goal with fluid resuscitation?
Reduce HR to <120 bpm
53
What is often initial therapy for pain management in pancreatitis?
Opioids
54
What should be given if a patient is given opioids?
Stimulant laxatives
55
What are 2 complications that can be seen if a patient is restricted from nutrition?
1. Increased intestinal mucosal atrophy 2. Infectious complications due to bacterial translocation from the gut
56
In severe cases, when should enteral nutrition be started?
Within 24-48 hours
57
How long should you withhold nutrition in mild pancreatitis?
Until the patient can tolerate oral intake (goal within 48 hours)
58
You should restart nutrition ______ when the patient can tolerate
Gradually
59
When do infections usually develop?
During the 2nd or 3rd week
60
What is the leading cause of morbidity and mortality with pancreatitis?
Infections
61
True or False: antibiotic prophylaxis is recommended
False
62
When can antibiotic prophylaxis be used?
1. When infection is suspected 2. Walled off area surrounding necrosis
63
What are 2 empiric antibiotics that can be used?
1. Imipenem 2. Meropenem
64
How long would you treat with empiric antibiotics?
14 days
65
What 4 things would help to prevent future pancreatitis flares?
1. Avoiding alcohol 2. Maintain appropriate TG level 3. Change to medications with less incidence of causing pancreatitis 4. Avoid ‘trigger’ foods

GI Exam 2 (11 decks)

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