05a: Da Pancreas Flashcards
Diagnosis of acute pancreatitis requires 2 out of which criteria?
- Characteristic abd pain
- Elevated serum lipase/amylase (3x ULN)
- Characteristic imaging findings
Characteristic pain in acute pancreatitis is quite similar to (X) pain, but is (exacerbated/alleviated) by (Y).
X = biliary cholic (acute onset, persistent and severe epigastric pain that radiates to back and exacerbated by eating)
Alleviated
Y = leaning forward
(Lipase/amylase) elevation is more specific for acute pancreatitis. It stays elevated for (shorter/longer) period of time.
Lipase (can increase 10x normal!); longer (72-96h)
Which imaging modalities used to diagnose acute pancreatitis? Star the preferred method.
CT*, MRI, US
Most (50%) cases of acute pancreatitis are attributed to:
Gallstones
Second most common cause of acute pancreatitis is:
EtOH (30%)
Patient presenting with acute pancreatitis. Which finding is considered incredibly high predictor of gallstone etiology (95% PPV!)?
ALT elevated 3x ULN
You diagnose patient with acute pancreatitis. What are your initial steps for therapy?
- NPO
- Analgesics
- Early, aggressive IV fluid resuscitation
Acute pancreatitis: IV fluids are preferentially (normal saline/lactate ringers) to prevent which complications?
Lactate ringers;
Metabolic acidosis and increased trypsinogen activation
“BISAP” scoring system used to predict (X). What does it stand for?
X = severity of acute pancreatitis
BUN over 25 mg/dL Impaired mental status SIRS Age over 60 Pleural effusion on imaging
T/F: Like other zymogens, pancreatic amylase and lipase are secreted in inactive forms.
False
Based on experimental models, the initiating event in acute pancreatitis is:
Intra-acinar conversion of trypsinogen to trypsin (resulting in acute intracell injury)
T/F: The magnitude
of serum amylase/lipase elevation correlates with the severity of pancreatitis.
False
Which two main complications of acute pancreatitis occur due to toxic materials (liberated by pancreas) reaching systemic circulation?
SIRS and MODS (multiple organ dysfunction syndrome)
T/F: All pancreatic pseudocysts are removed to avoid infection/compression.
False - asymptomatic ones are just followed
Fat necrosis is an example of (autodigestion/local spread/systemic spread) in acute pancreatitis.
Local spread
(X) tool is useful for distinguishing between interstitial and necrotizing pancreatitis. What is the difference between these?
X = CT (with contrast)
Interstitial: intact microcirculation (uniform enhancement)
Necrotizing: disrupted microcirculation (large areas won’t enhance with contrast)
(X) is the leading cause of mortality (80%) in acute pancreatitis.
X = infected necrosis
Treatment of infected necrosis (in acute pancreatitis) includes which drugs?
Antibiotics that penetrate pancreatic necrosis:
Carbapenems, quinolones, metronidazole
T/F: All patients with infected necrosis (secondary to acute pancreatitis) require debridement.
False - stable patients may only require antibiotics
Mild pancreatitis: when should oral diet be restarted?
Immediately after resolution of pain, N/V (early re-feeding associated with short hospital stays, decreased complications)
T/F: In severe pancreatitis, parenteral nutrition is preferred to avoid additional stress on the gut.
False! Enteral preferred;
TPN only if enteral route unavailable/not tolerated (higher risk of infection, organ failure, mortality)
T/F: The changes in chronic pancreatitis are fibro-inflammatory and irreversible.
True
Almost 75% of chronic pancreatitis is due to which etiology?
EtOH
