Acute pancreatitis Flashcards
(48 cards)
What is the mortality rate of severe pancreatitis?
up to 10% to 30%
mortality in pancreatitis has a bimodal distribution.
describe it and what is the most common cause of death?
EARLY PHASE - multiorgan dysfunction syndrome (most common). LATE PHASE - SEPTIC COMPLICATIONS
The most common cause of death is multiorgan dysfunction syndrome.
in the first 2 weeks (early phase), the multiorgan dysfunction syndrome is the final result of
an intense inflammatory cascade triggered initially by pancreatic inflammation.
Mortality after 2 weeks (late period), is often caused by septic complications.
which pprotease is responsible for cell death (and which cell) in acute pancreatitis?
The cytosolic cathepsin B induces apoptosis or necrosis, leading to acinar cell death.
what is the most common cause of pancreatitis?
how many cases in the U.S?
Gallstone pancreatitis.
40% of U.S. cases.
what is the incidence for a patient with gallstones to develop pancreatitis?
3 - 8 %
what are the two theories of pancreatitis mechanism?
Obstructive theory, pancreatic injury is the result of
excessive pressure inside the pancreatic duct. This increased intraductal pressure is the result of continuous secretion of pancreatic juice in the presence of pancreatic duct obstruction.
Reflux, theory proposes that stones become impacted in the ampulla of Vater and form a common channel that allows bile salt reflux into the pancreas. Animal models have shown that bile salts cause direct acinar cell necrosis because they increase the concentration
of calcium in the cytoplasm; however, this has never been proven in humans
what are the factors that contribute to ethanol-induced pancreatitis?
heavy ethanol abuse (>100 g/day for at least 5 years), smoking, and genetic predisposition.
what is the second most common cause
of pancreatitis worldwide. What percentage of cases?
Excessive ethanol consumption.
35% of cases
what type of anatomic obstruction can cause abnormal flow of pancreatic juice into the duodenum and pancreatic injury?
pancreatic tumors, parasites, and congenital defects
name an anatomic variation that can cause pancreatitis (controversial). what percentage of the population has this variation? what is the treatment?
Pancreas divisum. annular pancreas (less common).
present in 10% of the population.
5% to 10% lifetime risk for pancratitis
ERCP with minor papillotomy and stenting may be beneficial for such patients.
which parasite can cause pancreatitis?
Ascaris lumbricoides
What is the most common complication after ERCP. percentage?
Pancreatitis. up to 5% of patients!
90-95% mild pancreatitis
Up to 2% of acute pancreatitis cases are caused by medications. What are the most common agents?
sulfonamides, metronidazole, erythromycin,
tetracyclines, thiazides, furosemide, statins, acetaminophen and more…
Which metabolic factors can cause pancreatitis?
Hypertriglyceridemia and hypercalcemia
level of triglyceride that can cause pancreatitits?
> 1000 mg/dL - suspected
>2000 mg/dL - confirms the diagnosis
what are the cardinal symptoms of acute pancreatitis?
epigastric or periumbilical CONSTANT pain that radiates to the back. Up to 90% of patients have nausea or vomiting that typically does not relieve the pain
describe two rare findings of pancreatitis?
what causes them?
flank and periumbilical ecchymosis (Grey Turner and Cullen signs, respectively). Both are indicative
of retroperitoneal bleeding associated with severe pancreatitis.
possible physical examination findings of the lung on acute pancreatitis
Dullness to percussion and decreased breathing sounds in the left or, less commonly, in the right hemithorax suggest pleural effusion secondary to AP.
which of the two - amylase or lipase is more indicative for acute pancreatitis 24 - 48 hours after the onset and why?
lipase levels is a more sensitive indicator to
establish the diagnosis. Lipase is also a more specific marker of AP.
The serum half-life of amylase is shorter than that of lipase.
acute pancreatitis - lab results?
Typically hyperglycemic,
Leukocytosis
Liver enzyme elevation.
The elevation of alanine aminotransferase levels in the serum in the context of AP confirmed by high pancreatic enzyme levels has a positive predictive value of 95% in the diagnosis of acute biliary pancreatitis.
Combined with the presence of gallstones on ultrasound have an even higher sensitivity (97%) and specificity (100%) for diagnosing acute biliary pancreatitis.
Which findings can be found on simple abdominal radiograph of acute pancreatitis?
why should it be performed?
Althoughnot useful for diagnosis, they can help rule out other conditions, such as perforated ulcer disease. Nonspecific findings:
air-fluid levels suggestive of ileus, cutoff colon sign as
a result of colonic spasm at the splenic flexure, and widening of the duodenal C loop caused by severe pancreatic head edema.
the rule of US in acute pancreatitis
this test should always be ordered in patients with AP because of its high sensitivity (95%) in diagnosing gallstones.
The usefulness for diagnosis is limited by intra-abdominal fat and increased intestinal gas as a result of ileus.
What is the best modality for evaluation of the pancreatitis?
Contrast-enhanced computed tomography.
Noncontrast CT scanning may also be of value in the setting of renal failure by identifying fluid collections or extraluminal air
which phase of CT is the most valuable to evaluate pancreatitis?
portal venous phase
(65 to 70 seconds after injection of contrast material), which allows evaluation of the viability of the pancreatic parenchyma, amount of peripancreatic inflammation, and presence of intra-abdominal free air or fluid collections.
