B5-065 Pancreatitis

Question 1

treatment for acute pancreatitis caused by gallstones

Answer 1

• fluid
• anti-emetics
• pain control
• GI consult- lap chole

Question 2

keep patient NPO if they have acute pancreatitis caused by

Answer 2

hypertriglyceridemia

Question 3

treatment for acute pancreatitis caused by hypertriglyceridemia

Answer 3

insulin

Question 4

if acute pancreatitis due to autoimmune disorder is suspected, what lab should be ordered?

Answer 4

IG4

Question 5

treatment of acute pancreatitis due to autoimmune cause

Answer 5

steroids

Question 6

acute pancreatis can be caused by […] procedure

Answer 6

ERCP

Question 7

mid-epigastric pain radiating to back

Answer 7

acute pancreatitis

Question 8

discoloration of tissue on the flanks due to tissue catabolism of hemoglobin

Answer 8

turner’s sign

perforation or retroperitoneal bleed

Question 9

blue discoloration in the periumbilical region due to hemoperitoneum

Answer 9

cullen’s sign

Question 10

best imaging modality for acute pancreatitis

Answer 10

CT abdomen with contrast
US if you have hepatobiliary concerns

Question 11

diagnostic criteria for acute pancreatitis

Answer 11

• acute epigastric pain radiating to back
• 3x increase in serum lipase or amylase
• imaging findings consistent with disease

requires 2 of 3

Question 12

if the dx of acute pancreatitis is established by abdominal pain and serum pancreatic enzymes..

Answer 12

CT with contrast not normally required

Question 13

characterized by absence of organ failure/systemic complications

Answer 13

mild acute pancreatitis

Question 14

characterized by transient organ failure/systemic complications (resolves in 48 hrs)

Answer 14

moderately severe acute pancreatitis

AKI

Question 15

characterized by persistent organ failure that many involve one or more organs persisting greater than 48 hrs

Answer 15

severe acute pancreatitis

Question 16

BISAP score

Answer 16

• BUN > 25
• Impaired Mental Status
• SIRS
• Age > 60
• Pleural effusion

0-2 points = low mortality, 3-5= high mortality

Question 17

local complications of acute pancreatitis

3

Answer 17

• interstitial edamatous pancreatitis
• necrotizing pancreatitis
• vascular complications and hemorrhage

Question 18

systemic complications can refer not only to organ failure, but also

Answer 18

exacerbation of pre-existing comorbid conditions

CAD, HF, COPD

Question 19

on CECT, pancreatic parenchyma shows a relatively homogenous enhancement. no findings of pancreatic necrosis

Answer 19

interstitial edematous pancreatitis

Question 20

5-15% of acute peripacreatic fluid collections persist beyond 4 weeks. at that point they become a

Answer 20

psuedocyst

Question 21

• well defined non-epithelized wall
• contain no solid material

Answer 21

pancreatic pseudocysts

Question 22

• well circumscribed
• homogenous fluid density
• no non-liquid component
• well defined wall, completely encapsulated

Answer 22

pancreatic pseudocyst

Question 23

• heterogenous
• no defineable wall
• lack of pancreatic parenchymal enhancement with contrast

Answer 23

acute necrotic collection

Question 24

most common vascular complication of acute pancreatitis

Answer 24

venous thrombosis of splenic vein

Question 25

mainstay of pancreatitis treatment | 4

Answer 25

* fluids * pain management * anti-emetics * nutrition

Question 26

are antibiotics indicated in the treatment of acute pancreatitis?

Answer 26

no unless evidence of extrahepatic infection | ascending cholangitis, bacteremia, UTI, pneumonia

Question 27

when is enteral feeding indicated?

Answer 27

moderate to severe pancreatitis | start with NJ tube, gastro- or jejuno- tube may be necessary for severe

Question 28

nutrition should be addressed within [...] hours

Answer 28

24-72 | unless due to hypertriglyceridemia

Question 29

majority of infection is acute pancreatitis is caused by | 4

Answer 29

E coli pseudomonas klebsiella enterococcus

Question 30

antibiotics known to penetrate into pancreatic necrosis

Answer 30

* carbapenems * fluroquinolones * ceftazidime * cefepime + metronidazole

Question 31

* elevated amylase and lipase * cross sectional imaging findings of pancreatic edema and mesenteric stranding

Answer 31

simple interstitial pancreatitis

Question 32

when should cholecystectomy be performed following pancreatitis?

Answer 32

after the abdominal exam has normalized

Question 33

* improves outcomes * fewer readmissions for recurrent pancreatitis * decreases overall cost

Answer 33

early cholecystectomy | after abdominal exam normalizes

Question 34

best initial treatment for acute pancreatitis

Answer 34

* fluid resuscitation * correction of metabolites/electrolytes * early enteral nutrition

Question 35

there is no proven benefit to the use of [...] in acute pancreatitis

Answer 35

antibiotics

Question 36

encapsulated homogenous fluid collection older than 4 weeks

Answer 36

pancreatic pseudocyst

Question 37

heterogenous fluid collection would suggest

Answer 37

necrotizing pancreatitis | acute necrotic collection, walled off necrosis, etc

Question 38

best treatment for pancreatic pseudocyst

Answer 38

open/endoscopic cyst-gastrectomy

Question 39

percutaneous drainage is indicated for

Answer 39

fluid collections separate from pancreas

Question 40

necrosectomy is indicated for

Answer 40

necrotic pancreas

Question 41

psuedocysts less than [...] can be observed as they will resolve

Answer 41

6 cm

Question 42

diagnostic imaging modality of choice in acute pancreatitis

Answer 42

contrast enhanced CT

Question 43

best treatment for severe pancreatitis with infected fluid

Answer 43

* EUS * IV antibiotics * possible cystogastromy/necrosectomy