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Flashcards in Acute Pancreatitis Deck (17):
0

Diagnostic step for patients suspected pancreatitis from Cholelithiasis?

Right upper quadrant abdominal ultrasound

1

Patients with mild right upper quadrant abdominal pain with heavy meals?

Biliary colic

2

Pancreatitis versus biliary colic pain?

Location of pain: radiating straight to the back vs RUQ

Accompanied by nausea and vomiting vs not

3

Think severe pancreatitis with what initial signs?

WBC GALA
WBC >16,000
Glucose >200
LDH >350
AST > 250
Age >55

4

Think severe pancreatitis with what signs 48 hours After admission?

BASH
BUN rise > 5
Base deficit > 4
Arterial PO2 < 60
Serum calcium < 8
Hematocrit drops >10 points

5

Pancreatic pseudocyst?

Cyst within the pancreas not lying by epithelial cells, associated with chronic pancreatitis

6

Most common causes of pancreatitis in the US?

1. Alcohol especially following binge drinking
2. Biliary tract disease (gallstones)

7

When is hypertriglyceridemia a cause of acute pancreatitis?

Levels are more than 1000

8

When patients have no gallstones seen on ultrasound and no other predisposing factor likely cause of pancreatitis?

Biliary tract disease (biliary sludge, or sphincter of Oddi dysfunction)

9

Biliary sludge a.k.a.?

Microlithiasis

10

Acute pancreatitis: what makes pain better? What makes pain worse?

Sitting up and bending forward. Food.

11

Three reasons acute pancreatitis patients are volume depleted?

1. Vomiting
2. No oral intake
3. Inflammatory process creates third spacing, sequestering large volumes of fluid in the peritoneal cavity

12

Most common test to diagnose pancreatitis? Good for? Can also be elevated in?

More specific test?

Amylase level. Rises within hours and remains elevated for 3 to 4 days. GI Ischemia with infarction or perforation, vomiting

Serum lipase (remains elevated longer than amylase)

13

Treatment of pancreatitis?

1. pancreatic rest (withholding food or liquids by mouth)
2. narcotic analgesia (with meperidine)
3. IV fluids

14

One can oral liquid be restarted in patients with acute pancreatitis?

When the pain has largely subsided and the patient has bowel sounds

15

Most common cause of death in patients with pancreatitis?

Hypovolemic shock

16

Complications of pancreatitis? Tx?

Phlegmon - Solid mass of inflamed pancreas with areas of necrosis (can become secondarily infected resulting in pancreatic abscess). An abscess would need to get drained

Pancreatic pseudocyst (if they are smaller than 6 cm, thry usually resolve spontaneously)

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