G.I.T

Question 1

Acute Pancreatitis - Presentation

Answer 1

• Severe epigastric pain with nausea and vomiting

- Constant, intense and is referred to upper back

Question 2

Acute Pancreatitis - Characterization

Answer 2

-Acute onset of abdominal pain resulting from enzymatic necrosis and inflammation of pancreas

Question 3

Acute Pancreatitis - Associations (main)

Answer 3

-80% assoc w/ gallstones and alcoholism

Question 4

Acute Pancreatitis - Infectious causes

Answer 4

1. Mumps
2. Coxsackie
3. Mycoplasma

Question 5

Acute Pancreatitis - Drug causes

Answer 5

1. Diuretics
2. Azothioprine
3. Estrogens
4. Sulfanomides

Question 6

Acute Pancreatitis - ischemic causes

Answer 6

1. Shock
2. Trauma
3. Vascular thrombosis
4. Embolism
5. Vasculitis

Question 7

Acute Pancreatitis - Other causes of epigastric pain (differential)

Answer 7

1. Esophagitis (reflux)
2. Gastritis
3. Peptic Ulcers
4. Cholecystitis

Question 8

Acute Pancreatitis - Clincal Features

Answer 8

1) Leukocytosis
2) DIC
3) Hemolysis
4) Peripheral vascular collapse
5) Shock with ATN, ARDS
6) Hypocalcemia (due to saponification) - tetany
7) Raised amylase levels in first 24 hours
8) Raised lipase levels within 72-96 hours

Question 9

Acute Pancreatitis - Complications

Answer 9

1) ARDS
2) ATN
3) Pancreatic abscess

Question 10

Acute Pancreatitis - Morphology

Answer 10

1) Focal areas of fat necrosis in pancreas and peripancreatic tissues and abdominal cavity
2) Chalky white areas of Ca++ deposition (saponification) - appear radiopaque on radiographs
3) Severe cases - Necrosis of pancreatic tissue (acini, ducts, and islets) with hemorrhage (hemorrhagic pancreatitis)

Question 11

Chronic Pancreatitis - Characterization

Answer 11

Repeated bouts of mild to moderate pancreatic inflammation with loss of pancreatic parenchyma and its replacement by fibrous tissue

Question 12

Chronic Pancreatitis - Common epidemiology

Answer 12

middle aged alcoholics

Question 13

Chronic Pancreatitis - Etiology

Answer 13

1) Pancreatic Divisum
2) Autoimmune pancreatitis
3) Tropical Pancreatitis
4) Hereditary Pancreatitis
5) CFTR mutation associated
6) 40% no obvious cause

Question 14

Chronic Pancreatitis - Presentation

Answer 14

Repeated attacks or persistent moderate-severe abdominal and back pain

Question 15

Chronic Pancreatitis - Clinical Features

Answer 15

1) Malabsorption
2) Diabetes
3) Pseudocysts

Question 16

Chronic Pancreatitis - Complications

Answer 16

1) Pleural effusions
2) Pancreatic Pseudocyst
3) Diabetes
4) Pain from perineural fibrosis
5) Pancreatic calcification
6) Stones in pancreatic duct
7) Ascites
8) Fat malabsorption (steatorrhea, dec vit K)

Question 17

Autoimmune Pancreatits - Synonyms

Answer 17

1) Lymphoblastic Sclerosing Pancreatitis
2) Duct-destructive chronic pancreatitis
3) Sclerosing chronic pancreatitis