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SURGERY ROTATION! > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

Inflammation of the pancreas

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2
Q

What are the most common etiologies of acute pancreatitis in the US?

A

Alcohol abuse (50%)

Gallstones (30%)

Idiopathic (10%)

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3
Q

Acronym for causes of pancreatitis?

A

I GET SMASHED

Idiopathic

Gallstones Ethanol Trauma

Scorpion bite Mumps Autoimmune Steroids Hyperlipidemia ERCP Drugs

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4
Q

Sx of pancreatitis?

A

Epigastric pain (frequently radiates to back)

Nausea/Vomiting

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5
Q

What are the signs of pancreatitis?

A

Epigastric tenderness

Diffuse abdominal tenderness

Decreased bowel sounds (adynamic ileus)

Fever

Dehydration/shock

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6
Q

What is the DDx for pancreatitis?

A

Gastritis/PUD

Perforated viscus

Acute cholecystitis

SBO

Mesenteric ischemia/infarction

Ruptured AAA

Biliary colic

Inferior MI/pneumonia

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7
Q

What labs should be ordered if suspected pancreatitis?

A

CBC

LFT

Amylase/Lipase

Type/cross

ABG

Calcium

Chemistry

Coags

Serum lipids

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8
Q

What are the associated lab findings with pancreatitis?

A

Labs: High amylase/lipase, high WBC

AXR: Sentinel loop, colon cutoff, possibly gallstones (10% visible on xray)

U/S: Phelgmon, cholelithiasis

CT: Phlegmon, pancreatic necrosis

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9
Q

What is the most common sign of pancreatitis on AXR?

A

Sentinel loops

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10
Q

What is the treatment for pancreatitis?

A

NPO

IVF

NGT if vomiting

H2 blockers/PPI

Analgesia (Demerol)

Correction of coags/electrolytes

Alcohol prophylaxis

“tincture of time”

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11
Q

What are the possible complications of pancreatitis?

A

Pseudocyst

Abscess/infection

pancreatic necrosis

splenic/mesenteric/portal vessel rupture of thrombosis

pancreatic ascites/pancreatic pleural effusion

DM

ARDS/sepsis/MOF

Coagulopathy/DIC

Encephalopathy

Severe hypocalcemia

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12
Q

What is the prognosis of pancreatitis?

A

Based on Ranson’s criteria

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13
Q

What is the Ranson’s criteria for the initial 48 hours?

A
  1. Base deficit >4
  2. BUN increase > 5mg/dL
  3. Fluid sequestration >6L
  4. Serum Ca <8
  5. Hct decrease >10%
  6. PO2 (ABG) <60mmHg
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14
Q

What is Ranson’s criteria at presentation of pancreatitis?

A
  1. Age >55
  2. WBC > 16,000
  3. Glucose > 200
  4. AST > 250
  5. LDH >350
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15
Q

Are postpyloric tube feeds safe in acute pancreatitis?

A

Yes!

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16
Q

What are the mortality rates for positive Ranson’s criteria?

A

0-2: <5%

3-4: ~15%

5-6: ~40%

7-8: ~100%

17
Q

Why does hypocalcemia occur in pancreatitis?

A

fat saponifications: fat necrosis binds to calcium

18
Q

What complication is associated with splenic vein thrombosis?

A

Gastric varices

(treat with splenectomy)

19
Q

Can TPN with lipids be given to a patient with pancreatitis?

A

Yes if the patient doesn’t suffer from hyperlipidemia

(triglycerides <300)

20
Q

What is the least common cause of acute pancreatitis (MOST commonly asked on rounds)?

A

Scorpion bite

21
Q

What is chronic pancreatitis?

A

Chronic inflammation of the pancreas region causing destruction of parenchyma, fibrosis, and calcification, resulting in loss of endocrine and exocrine tissue

22
Q

What are the two subtypes of chronic pancreatitis?

A

Chronic calcific pancreatitis

Chronic obstructive pancreaitis (5%)

23
Q

Causes of chronic pancreatitis?

A

Alcohol abuse (MC-70%)

Idiopathic (15%)

Hypercalcemia (Hyperparathyroidism)

Hyperlipidemia

Familial

Trauma

Iatrogenic

Gallstones

24
Q

What are the sx of chronic pancreatitis?

A

Epigastric and/or back pain

Weight loss

Steatorrhea

25
Q

What are associated signs with chronic pancreatitis?

A

Type 1 DM (up to 1/3)

Steatorrhea (up to 1/4)

Weight loss

26
Q

What are the signs of pancreatic exocine insufficiency?

A

Steatorrhea (fat malabsorption from lipase insufficiency-stools will float in water)

Malnutrition

27
Q

What are the signs of pancreatic endocrine insufficiency?

A

Diabetes (glucose intolerance)

28
Q

What are the common pain patterns with chronic pancreatitis?

A

Unrelenting pain

Recurrent pain

29
Q

What is the DDx with pancreatitis?

A

PUD

Biliary tract disease

AAA

Pancreatic cancer

Angina

30
Q

What % of patients with chronic pancreatitis have or will develop pancreatic cancer?

A

2%

31
Q
A

SURGERY ROTATION! (4 decks)

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