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GI/Hepatic Final > Pancreatitis > Flashcards

Pancreatitis Flashcards

(59 cards)

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1
Q

What drugs affect the pancreas?

A

Cipro
APAP
Meropenem
Opioids

Somatostatin
Tramadol
Octreotide
Metronidazole
Pancreatic enzymes
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2
Q

What drugs have endocrine functions?

A

Insulin (beta-cells)
Glucagon (alpha-cells)
Somatostatin

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3
Q

What drugs have exocrine function?

A

Secretion of isotonic fluid
Bicarbonate (to neutralize acid)
Pancreatic enzymes to neutralize food)

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4
Q

Pancreatic enzymes?

A 
Proteolytic
Amylolytic
Lipolytic
Nucleolytic
Miscellaneous
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5
Q

Pancreatic enzymes: proteolytic

A

Trypsinogen

Chymotrypsinogen

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6
Q

Pancreatic enzymes: Amylolytic

A

Amylase

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7
Q

Pancreatic enzymes: Lipolytic

A

Lipase
Phospholipase A2
Carboxylesterase lipase

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8
Q

Pancreatic enzymes: Nucleolytic

A

Ribonuclease

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9
Q

Pancreatic enzymes: miscellaneous

A

Trypsin inhibitor

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10
Q

Normal sequence of events for pancreatic stimulation

A

Cephalic (when you are hungry)
Gastric (starts to ramp up and pump out fluid)
Intestinal

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11
Q

What enzymes are secreted in the intestine?

A

Secretin

Cholecystokinin

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12
Q

Where are zymogens activated?

A

Duodenum

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13
Q

What enzyme activates other enzymes?

A

Trypsin

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14
Q

What is the primary cause of acute pancreatitis?

A

Gall stones

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15
Q

What toxins cause acute pancreatitis?

A

Alcohol

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16
Q

What are the causes of acute pancreatitis?

A 
Structural
Toxins
Infectious
Metabolic
Medication
Trauma
Vascular
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17
Q

Metabolic causes of acute pancreatitis?

A

Genetic hypertriglyceridemia

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18
Q

What medications can cause acute pancreatitics

A

Valproic acid
GLP-1 agonists
Sulfonamides
DPP4 inhibitors

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19
Q

What clinical presentations is in 100% of patients with acute pancreatitis?

A

Abdominal pain

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20
Q

What are the clinical presentations of acute pancreatitis?

A

Ab pain
Nausea +/- vomiting
Ab distention
Fever
Hypotension
Pancreatic inflammation and/or necrosis, increased CRP
Leukocytosis, hyperglycemia, hypoalbuminemia, hyperbilirubinemia
Elevated alkaline phosphatase and liver transaminases
Dehydration
Hypocalcemia

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21
Q

What are the options for imaging for acute pancreatitis?

A 
Ab Xray
Ab ultrasound
CT
ERCP
EUS
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22
Q

How is acute pancreatitis diagnosed?

A

Characteristic ab pain
Serum amylase and/or lipase >/= 3 times ULN
Imaging if needed

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23
Q

What are the principles for the severity and risk prediction of mild acute pancreatitis?

A

No organ failure

No complications

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24
Q

What are the principles for the severity and risk prediction of moderately severe acute pancreatitis?

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A

Local complications AND/OR transient organ failure

25
What are the principles for the severity and risk prediction of severe acute pancreatitis?
Persistent organ failure
26
What are the complications of acute pancreatitis?
``` Pancreatic ascites Pseudocyst Abscess Necrosis Systemic complications ```
27
What are pancreatic ascites?
Pancreatic secretions spread throughout peritoneal cavity
28
What are pseudocysts?
Collecting of pancreatic juice enclosed by a wall of fibrous tissue
29
What causes pseudocysts?
Pancreatic juice persistently leaking from the pancreatic duct
30
What causes pancreatic ascites?
Increased permeability d/t inflammation
31
What causes abscesses in acute pancreatitis?
Follows infection of pancreatic or peripancreatic necrosis
32
What defines necrosis in acute pancreatitis?
Presence of 1+ diffuse or focal areas of nonviable pancreatic parenchyma *may be sterile or infected*
33
What are systemic complications of acute pancreatitis?
CV, renal, pulmonary
34
What are the causes of systemic complications in acute pancreatitis?
Hypovolemia | Hypotension
35
What are the supportive care treatments for ALL patients with acute pancreatitis?
Fluid resuscitation Nutrition Pain control Antiemetics
36
What is used in fluid resuscitation of acute pancreatitis?
Lactated ringers or NS | Correct intra-vascular volume depletion
37
What is nutrition used for in acute pancreatitis?
Enteral over parenteral | Beginning within 48 hours shows benefit
38
How is pain controlled in pancreatitis?
IV/PCA Continued until able to tolerate PO Morphine (not in AKI), Dilaudid, fentanyl
39
What are additional cares for moderately severe and severe acute pancreatitis?
Supportive care for end organ damage Surgical care for local complications, if minimal/no improvement Judicious use of abx and antisecretory agents, as appropriate
40
What abx are used in acute pancreatitis?
Ceph Quinalones + Flagyl Carbapenems
41
Why are abx used in acute pancreatitis?
May decrease complications in necrotic pancreatitis Prophylactic abx not warranted Spectrum should include GI pathogens
42
What antisecretory agents are used in acute pancreatitis?
Octreotide | Somatostatin
43
What is the use of antisecretory agents in acute pancreatitis?
May inhibit pancreatic secretions Insufficient data to support use in all patients Routine use not in guidelines
44
What is the pathophysiology of acute pancreatitis?
Inflammation that leads to cellular necrosis and fibrosis Protein plug formation that blocks interlobular and intralobular ducts Progressive structural damage in ducts and tissues
45
What is the cause of the formation of a protein plug?
D/t high protein, low bicarbonate secretion
46
What is the clinical presentation of chronic pancreatitis?
Chronic ab pain (typically post prandial and associated with N/V) Recurrent episodes of acute pancreatitis Exocrine malfunction Endocrine malfunction
47
What are the results of exocrine malfunction?
Steatorrhea Malabsorption Vitamin deficiency (ADEK, B12)
48
What are the results of endocrine malfunction?
Diabetes
49
How do we diagnose chronic pancreatitis?
Amylase and lipase are nonspecific for chronic pancreatitis Ab CT/MRCP are sensitive but not specific for diagnosis Fecal fat and fecal elastase 1 concentrations may be helpful
50
What are ways to manage pain in chronic pancreatitis?
Lifestyle modifications
51
What are the lifestyle modifications for chronic pancreatitis pain management?
Alcohol and smoking cessation correlate with a reduction in pain Smaller meals, low-fat diet or elemental diets reduce pain and enzyme secretion
52
What are the options for chronic pancreatitis analgesia?
``` Antioxidants APAP NSAIDs Adjunct therapies Opioids ```
53
How are antioxidants used in chronic pancreatitis pain management?
Might be efficacious if used in combination with lifestyle medications
54
What concerns are there for APAP in chronic pancreatitis pain management?
With continued alcohol risk
55
What concerns are there for NSAIDs in chronic pancreatitis pain management?
Risk for GI bleeding
56
Which adjunct therapies in chronic pancreatitis pain management shows the most promise?
Pregabalin
57
What concerns are there for opioids in chronic pancreatitis pain management?
Development of dependence and tolerability. Opioid related ADR
58
How should pancreatic enzyme replacement therapy tablets be taken?
Give with acid suppression agent to increase efficacy | Take with food
59
How should pancreatic enzyme replacement therapy enteric coated be taken?
Microspheres can be administered with tube feedings

GI/Hepatic Final (6 decks)

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