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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

MEN2b

-marfans body habitus**
-neuromas of lips and tongue**
-medullary thyroid cancer- elevated calcitonin
-pheochromocytoma