Pancreatitis Flashcards
(23 cards)
def. panctreatitis 2 types
acute - infammation with no perm. injury
chronic - fibrosis, scarring, destruction
2 types of panc. functions
exocrine - digestive zymogens
endocrine - insulin, glucagon
patho in acute panc.
sudden panc. injury
- release of enzymes
- most mild/moderate
** 2 major causes and 4 minor causes
major - alc. and gallstones
minor - drugs, infection, hyperlipid, trauma
5 misc. causes if AP
- post-ERCP
- cardiac surg
- struct. abnormalility
- CF
- hereditary
how does gene/env change with age
more env. causes as we age
2 mech. of drug induced AP
- immunologically realted
- rash, eosiniphilia
- fast onset - chronic accumulation of toxic meatobolitess
- can be slow to dev.
reccemnedations for CF testing
- ion channel testing is main test
- not reccomend gene sequencing
4 local effects of enzyme release
- inflmmation
- third space losses
- fat necrosis
- pancreatic and peripancreatic necrosis
5 systemic effects of pancreatitis
- WBC chemotaxis
- DIC
- vessel attacks
- cell membrane destructiom
- fat necerosis
clin. presentation of AP
abdo pain
- epigastric
- radiation to back 1/3
- worse with food
- assoc. with nausea/vomiting
PE of AP
- tachymnea/cardia, hypotension
- icterus
- abdo dist.
- cullen, turner signs
- dullness at lung bases
- rebound tenderness
what are 2 serum markers and which is better
lipase - more specific and sens
amylase
- use lipase
2 major prognositic factors
- organ failure
- local complications
- necrosis
- abscess
- pseudocyst
3 levels of severity
self-limited: 75-85%
severe course - 15-25%
overall mort. : 3-5%
best predictors of severity (2)
- close obs
- good clinical judgement
- higher rates for BMI>29
treatment in AP (5)
no change in decades
- treat like burn
- fluids
- resp
- renal
- nutrition
- pain releif
7 possible complications of AP
- panc. necrosis
- sterile or infected - pancreatic pseudocyst
- can drain if large - hemmoragic
- cullen/grey turner - adult resp. distress syndrome
- panc. ascites/pleural effusion
- ascending cholangitis
- leads to infection of biliary tract - panc. abscess
causes of chronic panc (CP)
alc. 80%
Sx of CP
same as acute
Dx of CP
- CT
- xray can find calcifications, but only in 30%
- ERCP - gold standard but invasive
- lab studies not helpful
9 complications of CP
- narc. addictions
- DM/imparied glucose tolerance
- malabsorbtion/stehatorea
- pseudocyts
- abscess
- B12 def.
- panc. ductal dilatation
- effusions
9panc. carcinoma
2 Tx
- supportive
- NPO
- analgesics
- insulin
- alc. abstinece - surgery
