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Flashcards in Disorders of the Pancreas Deck (14):
1

Acute pancreatitis
Dx criteria

1.Acute onset of upper abdominal pain;
2.Serum amylase or lipase increased by at least 3 times of the upper limit of normal;
3.Characteristic findings on cross-sectional imaging (contrast CT, MRI, or SONO)

2

Acute pancreatitis
Dx modality

1. Abdominal ultrasound is required for every patient.
2.Contrast-enhanced CT is NOT usually required to diagnose acute pancreatitis.

3

Acute pancreatitis
Dx modality
when to use CT scan?

1.Diagnosis is uncertain (pain but minimal pancreatic enzyme elevation)
2.Presentation is severe and concerning for an undiagnosed intraabdominal complication;
3.Patients do not improve within 48-72 hours of hospital admission

4

Acute pancreatitis
Prognostic factors

1.Elevated serum BUN>20mg/dL
2.Hematocrit>44%;
3.Elevated Cr.

5

Acute pancreatitis
Rx principles

1.Fluid resuscitation.250-500cc/hour;
2.Pain control: opioids;
3.Antiemetics;
3.Brief bowel rest;

6

Acute pancreatitis
Brief bowel rest

1.Severe pancreatitis-->start within 72 hours;
2.Mild pancreatitis-->start when nausea/vomiting resolve (should not be based on Lipase levels);

7

Acute pancreatitis
Rx if d/t cholelithiasis

1.uncomplicated gallstone pancreatitis-->cholecystectomy should be performed prior to discharge;
2.if ascending cholangitis, ERCP should be performed within 24 hours of presentation

8

Acute pancreatitis
Antibiotics?

Do not give routine antibiotics;
If does not improved or deteriorates 7-10 days after-->antibiotics-->drain after 4 weeks to make it capsulated.

9

Acute pancreatitis
Complications

Pancreatic pseudocysts (interstitial pancreatitis) -->4 weeks;
Walled-off necrosis (pancreatic necrosis) -->4 weeks;
Gastric outlet dysfunction;
Splenic vein thrombosis;
Gastric variceal bleeding;
Colonic necrosis

10

Acute pancreatitis
Rx of pancreatic pseudocysts

usually, resolve on its own;
if symptomatic-->drainage

11

Acute pancreatitis
Rx of Walled-off necrosis

Many resolve on its own;
if symptomatic-->decompression or debridement

12

Chronic pancreatitis
Sx

1.Exocrine pancreatic insufficiency with bulky and greasy stools;
2.Fat-soluble vitamin deficiency and weight loss;
3.Diabetes;
4.Pancreatic calcification

13

Chronic pancreatitis
Dx

1. Pain, recurrent attacks of pancreatitis, weight loos;
2. Pancreatic calcification;
3. Ductal dilatation or inflammatory masses;
4. Exocrine pancreatic insufficiency
5. Diabetes
6. Histology findings.

14

Chronic pancreatitis
Causes

Alcohol and smoking are most common ones.