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Senior - Emed 3 > 3 - Pancreatitis And Cholecystitis > Flashcards

3 - Pancreatitis And Cholecystitis Flashcards

1
Q

Most cases of pancreatitis are:

A

Mild - involve only mild inflammation of the pancreas

Generally resolves with supportive care

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2
Q

Risk factors for pancreatitis

A

Smoking
DM
Obesity

Gallstones
Alcohol consumption

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3
Q

MCC’s of pancreatitis

A

Gallstones
EtOH
Idiopathic

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4
Q

Sxs of acute pancreatitis

A

Acute, severe, persistent abd pain

N/V

Anorexia

Decrease oral intake

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5
Q

Pain of pancreatitis

A

Epigastrium or occasionally in the left or right upper quadrants

May radiate to the back, chest, or flanks

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6
Q

What kind of pain is highly unlikely to be pancreatitis

A

Lower abdominal pain, dull or colicky pain

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7
Q

Cullen’s Sign

A

Belly button

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8
Q

Grey-Turner

A

Flanks

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9
Q

Formal dx of pancreatitis

A
  1. Looks like pancreatitis
  2. Lipase/amylase high
  3. Imaging

Need at least two of three criteria

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10
Q

Gold standard for lab (pancreatitis)?

A

None

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11
Q

Which is better - amylase or lipase?

A

Lipase better for dx’ing

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12
Q

Imaging for pancreatitis

A

CT Abdomen pelvis with IV contrast

However, if they meet criteria, you don’t HAVE to get imaging - just treat it - you’ve clinically diagnosed it

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13
Q

Characteristic findings on CT

A

Parenchymal inflammation
Parenchymal necrosis
Peripancreatic fluid collection
Pancreatic pseudocyst

(do not need to memorize)

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14
Q

Txt for pancreatitis

A

Supportive

Rehydration

2 to 4 L of fluid q 12 to 24 hrs

Txt the pain and nausea

No ABX

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15
Q

Local complications

A

Gastric outlet syndrome
Walled off necrosis
Splenic and portal vein thrombosis
Acute peripancreatic fluid collection

don’t need to memorize

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16
Q

MC’ly used scoring for pancreatitis

A

Ranson

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17
Q

SIRS (+) persistent for 48hrs good predictor of:

A

Acute pancreatitis

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18
Q

Features of criteria for predicting pancreatitis severity

A 
> 55yrs
Obese
AMS
Comorbidities
BUN > 20
Crit > 44%
Increase creat
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19
Q

Consider admission for:

A
  1. First time pancreatitis
  2. Biliary pancreatitis
  3. High pain med need
  4. Not able to drink / eat
  5. Persistent abnormal V/S
  6. And sign of organ insufficiency
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20
Q

When its biliary pancreatitis
And it don’t look good
Who you gonna call???

A

Surgeon, not medicine

Or the Ghostbusters, providers choice

21
Q

Mortality worse for acute or chronic pancreatitis?

A

Acute

22
Q

MC complication of gallstone disease?

A

Biliary colic

23
Q

What is uncommon but life-threatening for the gallbladder?

A

Perforation

24
Q

Emphysematous cholecystitis

A

Gas-producing organisms

25
Q

Acute acalculous cholecystitis occurs in the absence of:

A

Gallstones

Much less common but more serious

Occurs in the setting of critical illness like septic shock, burns, major trauma, or surgery

Old age, DM, immunosuppression are risk factors

26
Q

Biliary colic - pattern of pain

A

Coincides with meals, usually

Typically mild RUQ tenderness without peritoneal signs

MURPHY’S SIGN

27
Q

What is rarely seen with acute cholecystitis?

A

Jaundice

28
Q

Study of choice for acute cholecystitis

A

US

29
Q

Charcot’s Triad

A

Fever
RUQ pain
Jaundice

CHOLANGITIS

Pentad? Add AMS and shock (seen in less than 10% of cholangitis patients)

30
Q

Differential for gallbladder stuff (RUQ)

A

Could be appendix displaced superiorly

Could be chest stuff

31
Q

Labs for cholecystitis

A

WBC’s
CRP

Get LFT’s

32
Q

Why are plain films pointless?

A

Most stones don’t have enough calcium to show up

Thats why we use US (study of choice)

33
Q

Sonographic Murphy’s sign

A

Find the gallbladder

Compress the gallbladder with the probe

(+) pain reproduced - identified gallbladder as source of inflammation

34
Q

Good diagnostic tools for cholecystitis

A

Presence of stone on US

Sonographic Murphy’s sign

35
Q

If we see a large CBD, plan for:

A

MRCP (probably a stone causing obstruction)

36
Q

Can i r/o choledocholithiasis with US or CT?

A

Nope

37
Q

Normal common bile duct diameter

A

You’re allowed 6mm up to age 60yrs (i.e. 6.1mm = enlarged)

You’re allowed another mm each decade after 60yrs

If gallbladder was removed, they’re allowed up to 10mm of enlargement

MEMORIZE THIS STUFF

38
Q

Preferred initial imaging for acute cholecystitis

A

US

39
Q

Slide 54

A

Good chart of what findings go with what tests

40
Q

ED management for acute cholecystitis

A

Prophylactic ABX
NPO
mIVF
NSAIDs / opioids (try to avoid opioids if possible)

41
Q

If it’s biliary colic and they’re stable:

A

You can discharge to follow-up with a general surgeon (with instructions to return to ED if shit gets worse)

42
Q

Pt with acute cholecystitis or cholangitis

A

ADMIT! They’re really sick

Probably need
CCU

43
Q

Emphysematous cholecystitis - study of choice>?

A

IV contrast CT (to see air form gas-producing bacteria)

44
Q

Emphysematous cholecystitis prognosis

A

15% mortality - yikes

45
Q

Acalculous cholecystitis most commonly occurs in what setting?

A

Patients with critical illness

46
Q

Complications of acalculous cholecysititis

A

Gangrene

Perf

47
Q

If it looks like cholecystitis but they don’t have a gallbladder, consider:

A

Retained stone

48
Q

Billy has 32 candy bars, he eats 28 of them. What does Billy have now?

A

Diabetes

Senior - Emed 3 (7 decks)

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