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
Three main clinical manifestations of chronic pancreatitis:
- Abdominal pain (similar to that in acute pancreatitis)
- Fat and fat-soluble vitamin malabsorption (exocrine insufficiency)
- Diabetes (endocrine insufficiency)
Which 3 main imaging methods used to diagnose chronic pancreatitis?
CT, MRCP, EUS
(X) CT finding is pathognomonic (indicative of) chronic pancreatitis. Which other findings might be present?
X = calcifications in pancreas
Atrophy, fatty replacement, ductal dilation
(X) imaging modality is excellent for evaluation of biliary/pancreatic duct changes in chronic pancreatitis.
X = MRCP
(X) imaging modality is useful for detecting mild chronic pancreatitis (before radiographic abnormalities are evident).
X = EUS (Endoscopic ultrasound)
Diabetes is a(n) (early/late) complication of chronic pancreatitis. About (X)% of gland is damaged when clinical diabetes becomes apparent.
Late;
X = 80-90
(X) is the gold standard functional test for diagnosis of chronic pancreatitis.
X = secretin stimulation
With diagnostic decrease in HCO3 production, even in early pancreatitis
(Fecal/serum) measurement of (X) is seen as superior to serum trympsinogen and fecal chymotrypsin in testing function of (Y).
Fecal
X = elastase
Y = pancreas (i.e. for chronic pancreatitis)
Chronic pancreatitis Rx is focused on managing:
- Pain
2. Exocrine/endocrine insufficiency
Diet/supplementation in chronic pancreatitis involves:
- Low fat diet
- Vitamin and pancreatic enzyme supplementation
- Diabetes control
Patient with CKD and HCV infection can be treated with (X) combo for which genotypes?
X = Grazoprevir (NS3/4A inhibitor) and Elbasvir (NS5A inhibitor)
Genotypes 1 and 4
Patient with decompensated cirrhosis and HCV (Genotype 2) should be treated with (X) drug combo, which covers which genotypes?
X = Velpatasvir (NS5Ai) and Sofosbuvir (NS5Bi)
All (1-6) genotype
Patient with decompensated cirrhosis and HCV (Genotype 5) can be treated with (X) drug combo, which covers which SELECT genotypes?
X = Ledipasvir (NS5Ai) and Sofosbuvir (NS5Bi)
Genotypes 1,4-6
