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Year2 GI Exam II > Abdominal Pain and Pancreatic DIsease CIS - Darrow > Flashcards

Abdominal Pain and Pancreatic DIsease CIS - Darrow Flashcards

1
Q

62yo F obese diabetic acute epigastric pain

  • alcohol
  • elevated amylase and lipase
  • WBC elevated
  • AST/ALT elevated

most likely cause of pancreatitis?

next day - BUN increased and C-RP is elevated, drop in hemoglobin, creatinine elevated
-abdominal bruising

-pt improves -but 6 weeks later - pseudocyst

A

pancreatitis

-follow the BUN

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2
Q

acute pancreatitis

A

need 2 of 3 criteria

  • epigastric pain to back
  • amylase or lipase > 3x normal
  • characteristic finding on CT
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3
Q

obesity and pancreatic disease

A

bad
-central obesity - metabolically active organ

local circulatory changes in peripancreatic fat and produces hypoxia by limiting respiration

BMI > 30 poor prognosis

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4
Q

elevated amylase

A

non-specific

-macroamylasemia** - amylase too big to get through kidn
ey
-bowel problems
-ectopic production
-renal insufficiency
-trauma
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5
Q

labs for pancreatitis

A

best test - lipase

amylase is non-specific

ALT >150 suggest biliary pancreatitis

urine for trypsinogen activation peptie (TAP)

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6
Q

ALT > 150

A

suggest gallstones as pancreatitis cause

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7
Q

causes of acute pancreatitis

A

gallstones
alcohol
idiopathic
drugs, genetic, metabolic, vascular, autoimmune

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8
Q

IgG4

A

autoimmune

acute pancreatitis

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9
Q

genetic pancreatitis

A

can give predisposition

CASR, PRSS1, SPINK1 mutations

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10
Q

cullens sign

A

blood around umbilicus

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11
Q

grey turner sign

A

blood around flanks

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12
Q

intraperitoneal bleeding

A

cullens sign
grey turner sign

can occur in hemorrhagic pancreatitis

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13
Q

ranson criteria

A

predict severity of pancreatitis

above 3 - bad

age, WBC, glucose, LDH, AST

at 48 hours repeat - includes BUN and other criteria

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14
Q

APACHE II

A

score above 8 - bad - necrosis

used to assess severity of pancreatitis

rectal temp, MAP, HR, RR, FiO2, arterial pH, Na, K, Cr, Hct, WBC

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15
Q

HAPS score

A

harmless acute pancreatitis score

  • absence of rebound tenderness
  • normal hemacrit, normal creatine
  • better prognosis

predicts non-severe course

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16
Q

SIRS

A

high pulse
high respirations
high WBC

can occur in pancreatitis
-toward shock

systemic immune response syndrome

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17
Q

BISAP-B score

A

BUN, impaired mentality, SIRS, age >60, pleural effusion

3 or more - bad sign

with pancreatitis

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18
Q

C-RP

A

> 150 - pancreatic necrosis

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19
Q

Cr

A

> 1.8 - necrosis

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20
Q

hemacrit

A

> 44% - necrosis

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21
Q

clinical presentation for acute pancreatitis

A 
epigastric pain to back
mid abdominal staining - bruising (cullens and grey turners)
-yellow - jaundice
-lipase 
-left sided pleural effusion
-amylase
-sentinel loop and colon cut off signs
-emesis and nausea
22
Q 
epigastric pain to back
mid abdominal staining - bruising (cullens and grey turners)
-yellow - jaundice
-lipase 
-left sided pleural effusion
-amylase
-sentinel loop and colon cut off signs
-emesis and nausea
A

acute pancreatitis

lipase - best test

23
Q

CT severity index

A

to determine prognosis of patient with pancreatitis

24
Q

first test for suspected gall stone pancreatitis

A

US

25
Q

dark on CT

A

pancreatic necrosis

26
Q

necrotizing pancreatitis

A

50% change of infection that can become abscess and 30% chance of mortality

27
Q

complications of acute pancreatitis

A

ransom > 3
apache > 8

multiple organ dysfunction - BP < 90, pO2 < 60, Cr > 2, GI bleed

systemic - DIC, hypocalcemia

ascites, pseudocyst, chronic pancreatitis

28
Q

hypocalcemia

A

complication of acute pancreatitis - bad thing - indicates more saponification

29
Q

tx of pancreatitis

A
  • apply criteria
  • fine needle aspiration and drain
  • ERCP

-evidence of progression - enteral formula through feeding tube below ligament of trietz

30
Q

antibiotics for pancreatitis

A

imipenem

31
Q

celiac artery

A

spleen and stomach

32
Q

35yo M 3 bouts of pancreatitis, epigastric pain, weight loss, bulky stools 5 weeks
-glucose 250

A

chronic pancreatitis - on X-ray - expect to see calcified pancreas

33
Q

calcification, pain, steatorrhea, osmotic diarrhea, weight loss, vit deficiency, diabetes, epigastric pain

A

chronic pancreatitis

34
Q

diagnosis of chronic pancreatitis

A
  • Xray - calcification
  • US/CT - ductal dilation
  • ERCP - most sensitive and specific**
  • MRI - with cholangiopancreatography
35
Q

secretin/CCK secretion test

A

for chronic pancreatitis

36
Q

24 hour fecal fat

A

test for chronic pancreatitis

37
Q

pancreatic vs. intestinal steatorrhea

A

pancreatic - secretin test, fecal elastase tests

intestine - D-xylose, schilling test

38
Q

d-xylose test

A

less than 4g of 25g d-xylose measured in urine over 5 hours
-mucosal malabsorption or bacterial overgrowth

pancreatic - d-xylose is not effected - so urine has adequate d-xylose

39
Q

tx chronic pancreatitis

A

-drug for pain
low fat diet
-lipase with meals with H2 blocker
-watch for cancer

40
Q

pt over 50yo who develops diabetes no risk fx

A

look for chronic pancreatitis

41
Q

pneumatosis intestinalis

A

air in bowel wall
-can be benign or life-threatening

benign - COPD, scleroderma, crohns, corticosteroids

life-threatening - mesenteric vascular ischemia

42
Q

LUQ pain and splenomegaly, low RBC, platelets, WBC

peripheral smear - lymphos with hair-like projections

A

hairy cell leukemia - subgroup of chronic lymphocytic leukemia (CLL)

main markers - big spleen**

43
Q

hairy cell leukemia

A

malignant immature B cells

44
Q

periumbilical pain, rash, stridor, diffuse cramps

  • following fall at work
  • two prior episodes of edema, feet, labia 3 days after horseback riding
  • chicken wire loops on back
  • CT - edema of bowel wall
A

trauma - activation of complement pathway

C1 esterase deficiency**

45
Q

chicken wire loops

A

urticarial rash and edema with swelling

C1 esterase deficiency

46
Q

bradykinin

A

can cause edema

coag system can stimulate its release

47
Q

C4 with low C1 in acquired angioedema and normal C1 in HAE

A

chicken wire appearance

HAE - prodrome rash

C1 esterase deficiency

48
Q

23yo F diffuse abdominal pain, constipation, 2 months

  • hyponatremia
  • fad diet - last 6 months
  • depression
  • numbness of left arm and right leg
  • pupils dilated and HR rapid
A

acute intermittant porphyria
-deficiency of phophobilinogen deaminase

“porphyria”

49
Q

16yo M fever and diffuse abdominal pain, appendectomy one year ago, pleural rub over right posterior chest, tender scrotum, ankle rash, WBC and sed rate increased

A

familial mediterrean fever

50
Q

familial mediterrean fever

A

IL-8 disease - overactive

chronic - amyloid** - acute phase reactant

WBC mobbing tissue spaces - pathergy

51
Q

amyloid production

A

familial mediterranean fever

die from kidney failure

52
Q

45yo black M RUQ pain
-tender and pedal edema

CXR - cardiomyopathy
EKG - hypercalcemia

A

hypercalcemia, sarcoidosis**
-restrictive cardiomyopathy

-high pulmonary pressures - with restrictive cardiomyopathy - can lead to liver congestion

Year2 GI Exam II (18 decks)

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