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Clin med GI > pancreatic disorders > Flashcards

pancreatic disorders Flashcards

(70 cards)

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1
Q

What is the exocrine function of the pancreas

A

digestion
*secretes bicarb and digestive enzymes

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2
Q

What is the pancreas endocrine function

A

glucose homeostasis

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3
Q

What are the most common triggers of acute pancreatitis

A

gallstones and alcohol intake

*hypertriglyceridemia and ACEi are also common

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4
Q

What helps diagnosis of acute pancreatitis

A

serum amylase and Lipase
clinical presentation
imaging

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5
Q

What is the treatment for actor pancreatitis

A

IV fluids
analgesics
nutritional support

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6
Q

What toxins can cause acute pancreatitis

A

scorpion bites
organophosphate poisoning

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7
Q

What level of alcohol intake can lead to acute pancreatitis

A

> 4-7 drinks/day in men
3drinks/day in women

**generally from binge drinking rather than chronic

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8
Q

What is the patient presentation with acute pancreatitis

A

severe, upper abdominal pain with radiation (boring) to back with frequent N/V

diaphoretic and ill appearing

semi- comatose

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9
Q

What is grey turner sign and what is it associated with

A

ecchymoses of the flanks

acute pancreatitis

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10
Q

What is Cullen sign and what is it associated with

A

ecchymosis of the umbilical region

acute pancreatitis

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11
Q

What may help reduce some pain with acute pancreatitis

A

Sitting up ad leaning forward

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12
Q

What is the presentation difference between gallstone and alcohol pancreatitis

A

Gallstone occurs suddenly

alcohol occurs over a few days

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13
Q

What is the top differential dx is acute pancreatitis

A

perforated gastric/duodenal ulcer

*also r/o inferior wall MI

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14
Q

When is genetic testing recommended with acute pancreatitis

A

if <30y/o

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15
Q

When should a pancreatic tumor be highly considered with acute pancreatitis

A

> 40y/o

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16
Q

When should TG be considered as the cause of acute pancreatitis

A

> 1000mg/dl

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17
Q

What is the dx criteria for acute pancreatitis

A

Abdominal pain consistent with acute pancreatitis

serum lipase >3x upper limit of normal

Findings consistent on imagining

*need 2 of the 3

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18
Q

What lab work gives the best evaluation of acute pancreatitis

A

Rising BUN or rising Hct

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19
Q

What lab is most specific for pancreatitis

A

Lipase

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20
Q

How long do labs stay elevated with acute pancreatitis

A

Increase the first day and return to normal in 3-7 days

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21
Q

When may labs remain normal with acute pancreatitis

A

Destruction of acinar tissue in previous episodes

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22
Q

When may labs remain normal

A
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23
Q

If there is an elevated anion gap with acute pancreatitis, what is it indicative of

A

metabolic acidosis & shock

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24
Q

What is the imaging study of choice with pancreatitis

A

CTA

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25
what risk factors predict a severe course of acute pancreatitis
systemic inflammatory response syndrome (SIRS) AMS comorbid health problems BMI > 30 hypovolemia markers
26
What is the Ranson criteria
cumbersome, takes 48 hours could negative predictive value of acute pancreatitis
27
What is the APACHE II score
good negative predictive value of acute pancreatitis *complex & cumbersome
28
What is BISAP and what is it used for
Bedside index of severity in acute pancreatitis calculated during first 24 hours good positive predictor value of severe case M&M
29
What is the Balthazar score
CT severity index score based on the degree of necrosis and fluid presence for acute pancreatitis
30
What are the types of acute pancreatitis
Interstitial Necrotizing
31
What is mild acute pancreatitis
Inflammation confined to pancreas and close vicinity, no organ failure or systemic/local complications
32
What is mild acute pancreatitis
Local or systemic complications but no organ failure
33
What is severe acute pancreatitis
Peristent single or multi organ failure and 1 or more local complications
34
When is the most important stage in management of acute pancreatitis
in the first 12-24 hours -fluid resuscitation -analgesia - nutritional support
35
What is the foundation of acute pancreatitis management
early & aggressive fluid resuscitation *monitor BUN, Hct, and urine output Q4-6 hours in first 24 hours to adjust fluid rate
36
What is included in lactated ringers
Sodium, chloride, lactate, potassium, calcium
37
If there is no response to immediate management of acute pancreatitis, what is it indicative of
high likelihood of MODS/SIRS
38
How long does someone with acute pancreatitis need to stay NPO
until abdominal pain, n/v, appetite, ileum improve/resolve
39
If a patients acute pancreatitis is from gallstones, how do you manage their treatment
Cholecystectomy
40
If a patients acute pancreatitis is from cholangitis/billiary obstruction, how do you manage their treatment
ERCP w/n 24 hours of presentation
41
If a patients acute pancreatitis is from hypertriglyceridemia, how do you manage their treatment
bring down and maintain <500mg/dl *apheresis and insulin drip +/- glucose
42
What is a pancreatic pseudocyst
Pancreatic and peri pancreatic collections of enzyme rich fluid +/- necrotic material *most resolve spontaneously
43
What will be seen on imaging with acute pancreatic necrosis
gas bubbles on imaging/CT-guided percutaneous aspiration
44
When is surgery done for acute pancreatitis
if the organ has deteriorated despite abx
45
What criteria makes the dx for SIRS
Temp >38.3 or <36 HR >90bpm RR>20 WBC> 12,000 or <4000
46
What are the 2 major risk factors for chronic pancreatitis
alcohol and smoking
47
What is the predominant symptoms of chronic pancreatitis
abdominal pain
48
What is the treatment for chronic pancreatitis
pain control and mngmt of pancreatic insufficiency
49
What is chronic pancreatitis
Persistent inflammation due to permanent structural damage
50
What is the hallmark of chronic pancreatitis
Fibrosis caused by inflammation and recurrent pancreatic injury
51
What are the primary manifestations of chronic pancreatitis
abdominal pain and pancreatic insufficiency
52
What is steatorrhea
high fat stool
53
What are signs of pancreatic insufficiency
flatulence abdominal distention steatorrhea undernutrition weight loss fatigue
54
What is needed for diagnosis of chronic pancreatitis
Clinical assessment imaging pancreatic function tests
55
How may chronic pancreatitis look on KUB
Calcified
56
How may chronic pancreatitis appear on US
Atrophy with dilated main pancreatic duct with intraductsal calculi
57
What imaging modality is frequently used for chronic pancreatitis diagnosis
MRI
58
What type of pancreatic function tests are there
Direct (enzyme secretion) Indirect (fat malabsorption)
59
When is direct pancreatic function tests Most useful
in earlier stages when imaging isn't diagnostic
60
What is administered for diet pancreatic function test
IV CCK and then IV secretin for bicarb production
61
How do you treat chronic pancreatitis
Smoking/ETOH cessation pain control pancreatic enzyme supplements
62
What is used for indirect pancreatic function tests
Serum Trypsinogen Steatorrhea
63
How do you give pancreatic enzyme replacement
25k - 50k IU lipase per meal and half dose with snacks along with PPI/H2 blocker to prevent enzyme breakdown
64
Who may present with unopposed and prolonged hypoglycemia
pancreatogenic diabetes
65
What is exocrine pancreatic insufficiency (EPI)
Reduction in pancreatic enzyme activity *mainly lipase
66
What are the 2 primary causes of EPI
chronic pancreatitis in adults CF in children
67
How much pancreatic function is typically lost before EPI occurs
>90%
68
How do you treat / manage EPI
Monitor body weight / BMI Screen for nutritional deficiency referral to dietician address any causes
69
What is the mainstay treatment of exocrine pancreatic function
pancreatic enzyme replacement therapy (PERT)
70
What type of malabsorption happens first in EPI
Fat before carb/protein

Clin med GI (9 decks)

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