011415 pancreatitis

Question 1

acute pancreatitis

Answer 1

first TWO WEEKS:
SIRS, organ failure

after TWO WEEKS:
sepsis (fluid is infected) and its complications

Question 2

causes of acute pancreatitis are varied-how do their symptoms compare?

Answer 2

the same regardless of cause

Question 3

causes of acute pancreatitis

Answer 3

GALLSTONES
alcohol
hypertriglyceridemia
pancreas divisum
genetic causes (PRSS1, CFTR, SPINK1)

Question 4

PRSS1

Answer 4

causes hereditary pancreatitis b/c of lack of control of trypsin activity (either by preventing premature activation of trypsinogen or by destruction of trypsin from the pancreas)

Question 5

early acute changes in acute pancreatitis are due to

Answer 5

intraacinar activation of proteolytic enzymes (generates large amt of active trypsin within pancreas)

pancreatic autodigestion

Question 6

systemic complications are seen in what percentage of pts with acute pancreatitis?

Answer 6

minority

Question 7

persistent, severe epigastric abdominal pain that can radiate to the back

Answer 7

acute pancreatitis

Question 8

diagnosis of acute pancreatitis-lab findings

Answer 8

amylase elevated

lipase elevated

Question 9

acute pancreatitis-diagnosis requires two of the three:

Answer 9

constant epigastric or RUQ abd pain with radiation to back, chest or flanks

serum amylase and/or lipase is 3 times upper range of normal

characteristic abd imaging findings

Question 10

complications of acute pancreatitis

Answer 10

local:

• –acute peripancreatic fluid collection (under 4 wks) and pseudocysts (over 4 wks)
• –acute necrotic collection (infection of fluid collection)

Question 11

acute peripancreatic fluid and pseudocysts are related how?

Answer 11

they are the same thing (only difference is the time since acute pancreatitis has begun)

Question 12

causes of chronic pancreatitis

Answer 12

alcohol 
cigarette smoking
ductal obstruction (pancreas divisum)
ampullary obstruction (small cancer)
autoimmune pancreatitis
genetic

Question 13

imaging of chronic pancreatitis shows

Answer 13

pancreatic CALCIFICATION
ductal dilatation
enlargement of pancreas
fluid collections

Question 14

pathogenesis of chronic pancreatitis

Answer 14

proteinaceous ductal plugs within ducts—lead to calcifications–lead to stones within ducts, causing scarring and obstruction

Question 15

pseudocysts

Answer 15

ductal disruption (can cause pain)

Question 16

complications of chronic pancreatitis

Answer 16

bile duct or duodenal compression
infections from pseudocyst
higher risk of pancreatic adenocarcinoma