Flashcards in Pancreas CIS Deck (32):
1
criteria to dx acute pancreatis
(2 out of the 3)
-lipase level 3x the ULN
-epigastric pain
-changes on CT
2
acute pancreatitis- etiolgoy
-gallstones
-heavy alcohol use
-hypertriglyceridemia
-trauma
-ERCP
3
saponification
in acute pancreatitis!
-interaction of cations with free fa's released by the action of activated lipase on triglycerides in fat cells--> low blood calcium!!
4
amylase- elevated in other conditions
-high intestinal obstruction
-gastroenteritis
-mumps
-ectopic pregnancy
-opioids
-after abd surgery
5
acute pancreatitis- severity assessment
-Ranson criteria
-apache II (>8= higher mortality)
-atlanta classification
-CT grade of severity index
6
acute pancreatitis- independtly assoc with inc mortality
-SIRS and elevated BUN on admission with a rise in BUN within first 24 hrs of hospitalization
7
Ranson criteria- 3 or more- severe course with pancreatic necrosis
(acute pancreatitis)
GA-LAW- at admission
-Glucose >200
-Age>55
-LDH> 350
-AST >250
-WBC > 16,000
8
Ranson criteria- development of the following in the first 48 hrs indicates a worsening prognosis
C & HOBBS (48 hrs after admission)
-Calcium < 8
-Hematocrit drop > 10%
-oxygen (paO2) < 60
-Base deficit > 4
-BUN increase > 5
-sequestration of fluid > 6L
9
Ranson criteria- number of criteria and mortality rate
-0-2- 1%
-3-4- 16%
-5-6- 40%
-7-8- 100%
10
Atlanta criteria
(acute pancreatitis)
-mild- no organ failure, no local complications (fluid, pseudocyst, necrosis, pleural effusion)
-moderate- transient organ failure < 48 hrs, local complications +/-
-severe- persistent organ failure > 48 hrs
11
acute pancreatitis- imaging signs- xray
-"sentinel loop"- air filled small intestine
-"colon cutoff sign"- gas filled segment of transverse colon abruptly ending at area of pancreatic infl
12
acute pancreatitis- unenhanced CT
-demonstrate enlarged pancreas when dx is uncertain
13
acute pancreatitis- rapid-bolus IV contrast-enhanced CT
-ID areas of pancreatic necrosis
-should be avoided when serum Cr > 1.5!!!
14
severe acute pancreatitis- complications
-intravascular volume depletion
-pleural effusion
-necrosis
-pseudocysts
-ARDS
15
risk factors in SAP for high levels of fluid sequestration
-younger age
-alcohol etiology
-higher hematocrit value
-higher serum glucose within 48 hrs of admission
-SIRS
16
acute pancreatitis- treat the cause
-alcoholic- abstinence
-gallstone
-hypertriglyceridemia
-post ERCP prophylaxis
17
mild acute pancreatitis- tx
-80% resolve w/o complications
-pancreas rest- NPO, bed rest, NG suction for ileus
-fluid resuscitation
-pain control
-once pain free and BS- resume oral intake
18
severe acute pancreatitis- tx
-necrotizing- leakage of fluids- larger amts of IVF
-hemodynamic monitoring in ICU
-give calcium gluconate IV- for hypocalcemia with tetany
-serum albumin infusions for hypoalbuminemia
-shock- use pressors if fluids arent helping
-within 48 hrs- start enteral feedings with nasogastric tube- reduces risk of multiorgan failure and mortality!!!
19
acute pancreatitis- CT grade
-normal pancreas- 0
-pancreatic enlargement- 1- 0% mortality rate
-pancreatic infl and/or peripancreatic fat- 2; necrosis < 30%- <3% mortality rate
-single acute peripancreatic fluid collection- 3- necrosis 20-50%- 6% mortality rate
-2 or more peripancreatic fluid collections or retroperitoneal air- 4- necrosis >50%- >17% mortality rate
20
chronic pancreatitis- imaging- main sign
-calcifications in epigastric region
21
pancreatic cancer- sx, imaging sign
-painless jaundice, hyperbilirubinemia
-tumefactive chronic pancreatitis
22
chronic pancreatitis- etiology- mnemonic
TIGAR-O
-toxic-metabolic (alcoholic)
-idiopathic
-genetic- CFTR, PSTI, SPINK1, PRSS1
-autoimmune- IgG4
-recurrent
-obstructive
23
sentinel acute pancreatitis event
-pathogenesis of chronic pancreatitis
-event that initiates infl process- results in injury and then fibrosis
24
pancreatic fxn tests
-trypsinogen- low in insufficiency
-fecal elastase- low in insufficiency
-pancreatic malabsorption
-stimulation tests (CCK, secretin)
25
chronic pancreatitis- imaging
-xray- calcifications
-CT- calcification, ductal dilation
-ERCP
-EUS
26
chronic pancreatitis- complications
-DM
-pseudocyst or abscess
-bile duct stricture
-pancreatic insufficiency- steatorrhea, malnutrition
-osteoporosis
-pancreatic CA
27
pancreatic insufficiency- tests
-secretin stim test
-response to therapy with pancreatic enzyme supplements
-dec fecal chymotrypsin
-dec pancreatic fecal elastase
28
chronic pancreatitis- main cause of death
pancreatic cancer
29
most common place for gastrinoma
-duodenum!
-pancreas- second most common
30
MEN1
-pituitary adenoma- cushing
-parathyroid hyperplasia
-pancreas- tumors- gastrinoma, insulinoma
(PPP)
31
MEN2a
-thyroid- medullary thyroid cancer
-adrenal- pheochromocytoma
-parathyroid -parathyroid hyperplasia*
(TAP)
32