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GASTROENTEROLOGY > Pancreatitis > Flashcards

Pancreatitis Flashcards

(85 cards)

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1
Q

Main stimulator of secretion of water and electrolytes from the pancreatic ductal cells

A

Secretin (lesser extent, CCK)

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2
Q

Evokes an enzyme-rich secretion from pancreatic acinar cells

A

CCK

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3
Q

5 causes of acute pancreatitis

A

Gallstone, alcohol, ERCP, hypertriglyceridemia, drugs

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4
Q

Type of pancreatitis where pancreas blood supply is maintained

A

Interstitial pancreatitis

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5
Q

Type of pancreatitis where pancreas blood supply is interrupted

A

Necrotizing pancreatitis

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6
Q

Accepted pathogenic theory of acute pancreatitis where proteolytic enzymes are activated in the pancreas acinar cell rather than in the intestinal lumen due to premature activation of trypsin

A

Autodigestion

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7
Q

Major symptom of acute pancreatitis

A

Abdominal pain

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8
Q

Characteristic of abdominal pain in acute pancreatitis

A

Steady and boring in the epigastrium or periumbilical region, and may radiate to the back, chest, flanks, and lower abdomen

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9
Q

3 causes of shock in acute pancreatitis

A

o Hypovolemia
o Increased kinin peptides – causing vasodilation
o Systemic effects of proteolytic and lipolytic enzymes

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10
Q

Part of pancreas that is edematous when there is occurrence of jaundice

A

Head of the pancreas

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11
Q

Location of pleural effusion in acute pancreatitis

A

Left-sided

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12
Q

Faint blue discoloration around the umbilicus

A

Cullen’s sign

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13
Q

Cause of cullen’s sign

A

Hemoperitoneum

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14
Q

Blue-red-purple or green-brown discoloration of the flanks

A

Turner’s sign

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15
Q

Cause of Turner’s sign

A

Due to tissue catabolism of hemoglobin from severe necrotizing pancreatitis with hemorrhage

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16
Q

Serum amylase in acute pancreatitis returns to normal in how many days:

A

3-7 days

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17
Q

Serum lipase in acute pancreatitis returns to normal in how many days

A

7-14 days

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18
Q

Preferred test for acute pancreatitis

A

Lipase

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19
Q

More specific test for acute pancreatitis

A

Lipase

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20
Q

Harbinger of more severe disease (i.e. pancreatic necrosis) in acute pancreatitis

A

Hemoconcentration (Hct > 44%)

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21
Q

Cause of prerenal azotemia in acute pancreatitis

A

Due to loss of plasma intro the retroperitoneal space and peritoneal cavity

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22
Q

3 causes of hyperglycemia in acute pancreatitis:

A

o Decreased insulin release
o Increased glucagon release
o Increased output of adrenal glucocorticoids and catecholamines

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23
Q

Elevated ALP, AST and bilirubins in acute pancreatitis indicates involvement of:

A

Gallbladder and pancreatic head

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24
Q

Initial diagnostic imaging modality in acute pancreatitis

A

Abdominal ultrasound

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25
Criteria that categorized morphologic features of acute pancreatitis via CT scan:
Revised atlanta criteria
26
3 criteria for acute pancreatitis diagnosis (2 out 3)
o Typical abdominal pain in the epigastrium that may radiate to the back o 3-fold or greater elevation in serum lipase and/or amylase o Confirmatory findings of acute pancreatitis on cross-sectional abdominal imaging
27
4 markers of severity of acute pancreatitis
o Hemoconcentration (Hct > 44%) o Admission azotemia (BUN > 22 mg/dL) o SIRS o Signs of organ failure
28
2 Differences between the biliary colic and acute pancreatitis abdominal pain
o Pain of biliary tract origin is more-right sided or epigastric than umbilical or left upper quadrant o Ileus is usually absent
29
Criteria that defines phases of acute pancreatitis, outlines severity of acute pancreatitis, and clarifies imaging definition
Revised Atlanta criteria
30
2 phases of acute pancreatitis
o Early < 2 weeks | o Late > 2 weeks
31
Phase of acute pancreatitis where Severity is defined by clinical parameters rather than morphologic findings
Early phase
32
Most important clinical finding in regard to severity of the acute pancreatitis episode
Persistent organ failure – > 48 h
33
You must do CT imaging in the 1st 48 h of admission of acute pancreatitis: true or false
False
34
Radiographic feature of greatest importance to recognize in the late phase of acute pancreatitis
Necrotizing pancreatitis of CT
35
Difference between moderately severe and severe acute pancreatitis
o Moderately severe – transient organ failure (<48h) | o Severe – persistent organ failure (>48h)
36
Diffuse pancreatic enlargement and homogenous contrast enhancement on CT scan
Interstitial pancreatitis
37
Lack of pancreatic parenchymal enhancement by IV contrast on CT scan
Necrotizing pancreatitis
38
Most important treatment intervention for acute pancreatitis
Safe, aggressive IV fluid resuscitation
39
Better crystalloid for hydration in acute pancreatitis
Lactated Ringer’s
40
What is safe, aggressive IV fluid resuscitation in acute pancreatitis
15-20 ml/kg (1050-1400) mL as initial bolus followed by 2-3 ml/kg/hr (200-250 mL/h) to maintain UO > 0.5 ml/kg/hr
41
Why is Lactated Ringer’s solution a better crystalloid than NSS?
Decrease systemic inflammation
42
Strategy wherein there is measurement of hematocrit and BUN every 8-12 hrs to ensure adequacy of fluid resuscitation
Targeted resuscitation strategy
43
5 clinical and laboratory parameters in BISAP
``` o BUN > 25 mg/dL o Impaired mental status (GCS < 15) o SIRS o Age > 60 years o Pleural effusion ```
44
BISAP score that indicates increased risk for in-hospital mortality
≥ 3
45
Diet for mild acute pancreatitis (once abdominal pain resolved)
Low-fat solid diet
46
Preferred nutrition for more severe cases after 2-3 days of admission
Enteral nutrition (preferred than TPN)
47
Prophylactic antibiotics is recommended for necrotizing pancreatitis: True or false
False; broad spectrum antibiotic may be given if patient appears septic, then discontinued once with negative cultures
48
Definitive management of infected pancreatic necrosis
Pancreatic debridement (necrosectomy)
49
Persistent pancreatic fluid collections after 6 weeks
Pseudocyst
50
Diagnosis of pancreatic duct disruption is confirmed by what diagnostic?
MRCP or ERCP
51
> 90% effective at resolving the leak in pancreatic duct disruption
Bridging pancreatic stent (nonbridging are less effective)
52
3 perivascular complications of acute pancreatitis:
o Splenic vein thrombosis o Gastric varices o Pseudoaneurysm
53
Incidence of recurrent pancreatitis
25% of patients
54
2 most common etiologic factors of recurrent pancreatitis
o Alcohol | o Cholelithiasis
55
4 Cardinal manifestations of chronic pancreatitis
o Abdominal pain o Steatorrhea o Weight loss o Diabetes mellitus
56
Primary cause of chronic pancreatitis
Alcohol
57
Independent, dose-dependent risk factor for chronic pancreatitis and recurrent acute pancreatitis
Smoking
58
Most frequent cause of chronic pancreatitis in children
Cystic fibrosis
59
Pancreatitis that has the following histopathologic findings: Lymphoplasmacytic infiltrate, storiform fibrosis, abundant IgG4 cells
Autoimmune pancreatitis
60
Marker for autoimmune pancreatitis
IgG4 – elevated in 2/3 of patients
61
Criteria used in diagnosing autoimmune pancreatitis
Mayo Clinic HISORt criteria
62
Parameters in Mayo Clinic HISORt criteria for AIP
``` o At least 1 or more of the following:  Histology  Imaging  Serology  Other organ involvement  Response to glucocorticoid therapy ```
63
Treatment of AIP that as dramatic response within 2- to 4-week course
Glucocorticoids
64
Dose of prednisone in AIP
o Initial dose: 40 mg/day for 4 weeks | o Tapered by 5 mg/week
65
Very effective at inducing and maintaining remission in AIP
Rituximab
66
In chronic pancreatitis, patients seek medical attention predominantly because of 2 symptoms. What are these?
o Abdominal pain or maldigestion | o Weight loss
67
2 tests used in evaluation of suspected pancreatic steatorrhea
o Fecal-elastase-1 – abnormal (low) | o Small bowel biopsy – normal
68
Initial modality of choice in chronic pancreatitis
Abdominal CT imaging
69
Test that has best sensitivity and specificity in chronic pancreatitis
Hormone stimulation test using secretin
70
Radiographic findings that is pathognomonic for chronic pancreatitis
Diffuse calcifications on plain films
71
Arterial bleeding into the pancreatic duct
Hemosuccus pancreaticus
72
The cumulative risk of pancreatic carcinoma in chronic pancretitis
4% after 20 years
73
Cornerstone of therapy in pancreatic steatorrhea
Pancreatic enzyme replacement
74
Pancreatic enzyme replacement formulation must deliver sufficient amount of what substance into the duodenum to correct maldigestion and decrease steatorrhea?
Lipase
75
Hereditary pancreatitis is mutation on gene on what chromosome? What codons?
Chromosome 7, codons 29 and 122
76
Incidence of pancreatic carcinoma in hereditary pancreatitis at age 70
40%
77
Ventral pancreatic anlage fails to migrate correctly to make contact with the dorsal anlage
Annular pancreas
78
Ring of pancreatic tissue encircling the duodenum
Annular pancreas
79
Surgical procedure of choice for annular pancreas
Retrocolic duodenojejunostomy
80
Most common congenital anatomic variant of human pancreas
Pancreas divisum
81
Pancreas divisum does not predispose patients to pancreatitis: True or false
True
82
Appear as a small-caliber ventral duct with an arborizing pattern on ERCP/MRCP
Pancreas divisum
83
Treatment of pancreatitis with pancreas divisum
o Conservative | o Endoscopic or surgical intervention only if with recurrence
84
Diagnostic test for macroamylasemia
Serum chromatography
85
Amylase circulate in the blood in a polymer form too large to be easily excreted by the kidney
Macroamylasemia

GASTROENTEROLOGY (2 decks)

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