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Flashcards in Acute pancreatitis Deck (30):
1

What percentage of pancreatitis cases are mild to moderate?

70-85%

2

What is the pain like in acute pancreatitis?

steady and persistent for many hours. N/V
Pain is worse in the upper quadrants

3

What additional Sx will a pt with SEVERE acute pancreatitis have?

Tachycardia
Mental status changes
Hypotension
Hypoxia
Fever

4

Would the abdomen be rigid in pancreatitis?

NO--that's a peritoneal sign.

5

Grey-turner sign

ecchymosis in the flank region

6

Cullen sign

ecchymosis in the periumbilical region

7

What other things could cause an elevated amylase besides pancreatitis?

Cholecystitis
Bowel obstruction/perforation
Intestinal ischemia
Appendicitis
Ectopic pregnancy
Overian cysts
Lung cancer
Drugs
ERCP

8

Why is the serum lipase more sensitive?

All lipase comes from the pancreas

9

What other labs might be abnormal

WBC high, esp in severe pancreatitis
Glucose and LFTs high if gallstones are present
Calcium low

10

What imaging tests might help?

Plain abdominal films excludes perforation and intestinal obstruction
Abdominal CT: shows inflammation of pancreas, extent of inflammation, and necrosis

11

What is the downside to using a CT in suspected pancreatitis?

It may be normal in 15-30% of pts with mild pancreatitis won't show early signs in CT

12

What criteria are used to diagnose acute pancreatitis?

1. Abdominal pain consistent with acute pancreas
2. elevated amylase/lipase 3x normal limit
3. confirmation with X-sect abd imaging

13

What's your differential for pancreatitis?

cholecystitis
cholangitis
perforation
mesenteric ischemia
intestinal obstruction

MI
aortic dissection
ectopic pregnancy
crohn's

14

What are the two most common causes of acute pancreatitis?

alcohol abuse and gallstones (these comprise 80% of cases)

15

Do gallstones lead to chronic pancreatitis?

No--while alcohol can cause permanent structural changes, intermittent obstruction of the pancreatic duct usually does not.

16

What are less common causes of acute pancreatitis?

idiopathic (10-15%)
Hereditary
Hyperparathyroidism/hypercalcemia
Cancer
medications
hepatitis
toxins (trinidadian scorpion)
ERCP
Trauma
Inherited
Pregnancy

17

What are three inherited causes of acute pancreatitis?

1. Trypsinogen mutation (loss of inactivation binding site)
2. CFTR mutations: thickened mucus causes obstruction of bile duct, inaddition to malabsorption
3. Familial hypertriglyceridemia

18

How do you determine the severity of pancreatitis?

Use the ranson index, with 11 variables.

19

What is missing from the ranson index?

amylase/lipase elevation! These are elevated both in acute and chronic cases and don't tell you more than that.

20

Aside from the ranson index, what other prognostic indicators are there?

BISAP>2
-BUN>25
-Impaired mental status
-SIRS
-Age>60
-Pleural effusion

21

What are early complications of severe acute pancreatitis?

1. massive dehydration
2. hyperglycemia, hypocalcemia, electrolyte abnormalities, coagulopathy and hypoxia
3. SIRS

22

What is SIRS?

Systemic inflammatory response syndrome: Fever, tachycardia, tachypnea, elevated WBC

23

What are the late complications of acute pancreatitis?

Occurs after the 2nd week. Pseudocysts, abscesses, and GI hemorrhage
-->death from SIRS/sepsis/multiorgan failure. Can occur at any time.

24

How do you treat sterile necrosis of the pancreas? Infected necrosis?

1. Antibiotics, conservative
2. Antibiotics, debridement

25

How do you treat GI hemorrhage?

Transfuse, PPI, surgery

26

Why might pancreatitis cause a coagulopathy?

Circulating proteases

27

Why might someone with pancreatitis get acute renal failure?

Hypotension, causing pre-renal or hemodynamic ARF

28

How do you treat mild acute pancreatitis?

IV hydration
Nothing by mouth
Parenteral analgesia
Removal of risk factors (cholecystectomy or alcohol/medication removal)

29

How do you treat severe acute pancreatitis?

1. fluid/electrolyte replacement
2. Pain control
3. Nutrition thru a jejunal tube
4. Antibiotics: ONLY if established infection
5. Surgery: Drainage of symptomatic pseudocysts or debridement of infected necrosis
6. Emergent ERCP is controversial for gallstone removal

30

In gallstone pancreatitis, should you remove the gallstone after acute episode has resolved?

YES, because the recurrence rates are so high. Use cholecystectomy or ERCP prior to discharge.