43 - Pancreatitis

Question 1

acute pancreatitis

Answer 1

spillage of pancreatic enzymes into surrounding pancreatic tissue
>causes autodigestion + severe pain

degree of inflammation varies fr mild edema to severe hemorrhagic necrosis

Question 2

pancreatitis etiology

Answer 2

-ETOH
-biliary tract disease/gallstones
-treauma
-infectn
-drug/smoke
-post op GI
-unknown??

Question 3

patho causes

Answer 3

-activation of pancreatic enzyme in the pancreas instead of the intestines
-injury to pancreatic cells

Question 4

autodigestive effects of pancreatic enzymes

TRYPSIN

Answer 4

activation of trypsinogen to trypsin in the pancreas:

-edema
-necrosis
-hemorrhage

-when it leaks to abdomen, can cause green/yellow/brown discoloration

Question 5

autodigestive effects of pancreatic enzymes

ELASTASE

Answer 5

hemorrhage

Question 6

autodigestive effects of pancreatic enzymes

PHOSPHOLIPASE A + LIPASE

Answer 6

fat necrosis

Question 7

autodigestive effects of pancreatic enzymes

KALIKREIN

Answer 7

-edema
-vasc permeability
-smooth muscle contraction
-shock

Question 8

types of MILD pancreatitis

Answer 8

edematous or interstitial

Question 9

SEVERE pancreatitis

Answer 9

-NECROTIC
-more permanent
-organ failure
-sepsis

Question 10

most common manifestations

Answer 10

ab pain due to distention of pancreas, peritoneal irritation, + obstruction of biliary tract

**upper left quad or mid-epigastric
**radiate to back
**sudden onset

-eating worsens
-not resolved by vomiting

Question 11

manifestations

Answer 11

-n/v
-low grade fever
-leukocytosis
hypotension
-tachycardia (severe sign)
-jaundice
-ab guarding
-decr/absent bowel sounds
—-paralytic ileus
-crackles in l ungs
-grey turner’s spot
-cullens sign
-hypo-Ca (chvostek or Trousseau)

Question 12

hemorrhaging can lead to..

Answer 12

shock or toxemia

Question 13

2 complicationis

Answer 13

pseudocysts + abscess

Question 14

pancreatic pseudocysts

Answer 14

accum of fluid, enzymes, tissue debris, + inflmmtn exudates surrounded by a wall next to pancreas

Question 15

pancreatic pseudocysts
manifestations

Answer 15

-ab pain
-palpable epigastric mass
-n/v
-anorexia

-HIGH amylase

Question 16

pancreatic pseudocysts prognosis

Answer 16

-may be self limiting
-may perforate + cause peritonitis or rupture into stomach

Question 17

pancreatic abscess

Answer 17

infected pesudocysts

Question 18

everything is elevated except… from..

Answer 18

calcium
from fat necrosis

Question 19

elevated diagnostics

Answer 19

-serum/urinary amylase
-lipase
-glucose
-triglycerides

Question 20

primary diagnostic tests

Answer 20

serum amylase +lipase
-usually high early + stays high for 24-72 hrs

-lipase is more important

Question 21

best imaging test

Answer 21

CT scan

Question 22

Endoscopic retrograde cholangiopancreatography - ERCP

Answer 22

• check for obstruction in bile ducts

Question 23

if paralytic ileus or constipation is present, then avoid which meds/.

Answer 23

anticholinergics like ATROPINE
-use spasmolytics likr nitro or papaverine instead

Question 24

reduce/suppress pancreatic enzymes to decrease stimulation by…

Answer 24

RESTING
-NPO
-NG tube
-enteral support
-no ETOH/smoking
-low fat, high carb
-limit stress

Question 25

surgical therapy

Answer 25

ERCP + sphincterotomy (severingof muscle layers of sphincter of oddi)
-CT/edoscopy to drain severe necrotic fluid collection

Question 26

why do we not give parenteral nutrition?

Answer 26

because high risk for infection

Question 27

MEDICATION FOR PANCREATITIS

Answer 27

-antacids> decr secretion
-antispasmodics (dicyclomin)
-carbonic anhydrase inhibitors (acetazolamide)
-morphine
-PPI omeprazole> decr HCl secretion
-pancrelipase> replace penzymes

Question 28

best position for pain relief

Answer 28

-flex trunk
-draw knees up

-side lying w head up 45 degr