Pancreatitis Flashcards Preview

Clin Med 2 > Pancreatitis > Flashcards

Flashcards in Pancreatitis Deck (23):
1

Most pancreatitis cases are due to

gallstone and chronic alcohol abuse

2

Fxn pancreas

breaks down carbs, proteins, lipids

3

Acute pancreatitis

occurs suddenly and may result in life-threatening complications

4

Recurrent pancreatitis

25% will have recurrence; most due to alcohol or cholelithiasis

5

Cause of acute pancreatitis

Gallstone
alcohol
idiopathic
Post-ERCP
HyperTG
Hypercalcemia
Smoking
Drugs
Infection
Trauma

6

Complication acute pancreatitis

- multisystem organ failure- renal failure, acute respiratory distress syndromes, cardiac dysfunction
- intravascular depletion
ileus
pancreatic pseudocyst
pancreatic necrosis

7

Clinical acute pancreatitis

Midepigastric pain- patient lays forward and worst when laying back
pain radiates to back
N/V
dyspnea
epigastric tenderness
jaundice

8

Severe sx of acute pancreatitis

tachypnea
hypoxemia
hypotension
ARDS
cullen's sign
Grey turner syndrome

9

Cullen sign

- exomotic discoloration in periumbilical region due to bleeding intrabdominal
- most likely have necrotizing pancreatitis

10

Grey Turner sign

- exomatic discoloration along flanks due to hemorrhage
- most likely have necrotizing pancreatitis

11

Labs acute pancreatitis

Amylase 3xULN
Lipase 3xULN
CBC with diff- HCT increase
BMP- BUN/creatine elevated, hyperglycemia
LFT- hyperbilirubinemia, increase ALT+AST, direct bilirubin will be higher
LDH
C-reactive protein
Fasting TG over 1000

12

Imaging acute pancreatitis

CT abdomen with IV contrast
abdominal US
MRI

13

Essentials for Dx acute pancreatitis

2 of the following:
midepigastric pain +/- radiation into the back
lipase and/or amylase 3xULN
CT confirmation of pancreatitis

14

Tx Acute pancreatitis

Admit to hospital
Predictor score
Determine cause
NPO, IVF with lactated ringers
Parental analgesic, antiemetic
Rpt labs BUN/creatinine, HCT every 8-12hrs
Serial exams for fluid overload
clear fluids--> low fat diet

15

Predictors of acute pancreatitis

Banson criteria
APACHE 2 Score
SIRS Score
BISAP

16

SIRS Criteria

2 of the following
- temperature over 38.3 or less than 36
- HR over 90
RR over 20
WBC over 12,000

17

Chronic pancreatitis

- irreversible damage to the pancreas as distinct from the reversible changes noted in acute pancreatitis

18

Histology of chronic pancreatitis

chronic inflammation, fibrosis, progressive destruction of exocrine and endocrine tissue

19

Cause chronic pancreatitis

alcohol abuse
idiopathic
cigarette
cystic fibrosis (children)
genetic
autoimmune pancreatitis

20

chronic pancreatitis complications

narcotic addiction
DM
gastroparesis
malabsorption
biliary stricture
pancreatic carcinoma
hereditary pancreatitis

21

Clinical chronic pancreatitis

abdominal pain
anorexia
maldigestion
weight loss
N/V
steatorrhea
tenderness over pancreas during attacks

22

Dx chronic pancreatitis

Amylase and lipase- mild to normal
Glucose elevated
Secretin test-abnormal if >60% of pancreatic exocrine fxn lost
Abdominal CT (initial)

23

Tx chronic pancreatitis

-low fat diet, refrain from alcohol
- steatorrhea: PDA approved pancreatic enzyme
- Endoscopic tx: sphincterotomy, stenting, stone extraction, drainage of pseudocyst
- Whipple, total pancreatectomy, autologous islet cell transplantation