need 2 of 3 criteria - epigastric pain to back - amylase or lipase > 3x normal - characteristic finding on CT

harmless acute pancreatitis score - absence of rebound tenderness - normal hemacrit, normal creatine - better prognosis predicts non-severe course

Abdominal Pain and Pancreatic DIsease CIS - Darrow Flashcards by Amanda Beach

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

pancreatitis

-follow the BUN

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acute pancreatitis

need 2 of 3 criteria

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

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obesity and pancreatic disease

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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elevated amylase

non-specific

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

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labs for pancreatitis

best test - lipase

amylase is non-specific

ALT >150 suggest biliary pancreatitis

urine for trypsinogen activation peptie (TAP)

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ALT > 150

suggest gallstones as pancreatitis cause

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causes of acute pancreatitis

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

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IgG4

autoimmune

acute pancreatitis

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genetic pancreatitis

can give predisposition

CASR, PRSS1, SPINK1 mutations

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cullens sign

blood around umbilicus

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grey turner sign

blood around flanks

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intraperitoneal bleeding

cullens sign
grey turner sign

can occur in hemorrhagic pancreatitis

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ranson criteria

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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APACHE II

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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HAPS score

harmless acute pancreatitis score

absence of rebound tenderness
normal hemacrit, normal creatine
better prognosis

predicts non-severe course

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SIRS

high pulse
high respirations
high WBC

can occur in pancreatitis
-toward shock

systemic immune response syndrome

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BISAP-B score

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

3 or more - bad sign

with pancreatitis

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C-RP

> 150 - pancreatic necrosis

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> 1.8 - necrosis

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hemacrit

> 44% - necrosis

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clinical presentation for acute pancreatitis

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

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

acute pancreatitis

lipase - best test

CT severity index

to determine prognosis of patient with pancreatitis

first test for suspected gall stone pancreatitis

dark on CT

pancreatic necrosis

necrotizing pancreatitis

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

complications of acute pancreatitis

ransom > 3 apache > 8 multiple organ dysfunction - BP < 90, pO2 < 60, Cr > 2, GI bleed systemic - DIC, hypocalcemia ascites, pseudocyst, chronic pancreatitis

hypocalcemia

complication of acute pancreatitis - bad thing - indicates more saponification

tx of pancreatitis

- apply criteria - fine needle aspiration and drain - ERCP -evidence of progression - enteral formula through feeding tube below ligament of trietz

antibiotics for pancreatitis

imipenem

celiac artery

spleen and stomach

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

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

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

chronic pancreatitis

diagnosis of chronic pancreatitis

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

secretin/CCK secretion test

for chronic pancreatitis

24 hour fecal fat

test for chronic pancreatitis

pancreatic vs. intestinal steatorrhea

pancreatic - secretin test, fecal elastase tests intestine - D-xylose, schilling test

d-xylose test

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

tx chronic pancreatitis

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

pt over 50yo who develops diabetes no risk fx

look for chronic pancreatitis

pneumatosis intestinalis

air in bowel wall -can be benign or life-threatening benign - COPD, scleroderma, crohns, corticosteroids life-threatening - mesenteric vascular ischemia

LUQ pain and splenomegaly, low RBC, platelets, WBC peripheral smear - lymphos with hair-like projections

hairy cell leukemia - subgroup of chronic lymphocytic leukemia (CLL) main markers - big spleen**

hairy cell leukemia

malignant immature B cells

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

trauma - activation of complement pathway C1 esterase deficiency**

chicken wire loops

urticarial rash and edema with swelling C1 esterase deficiency

bradykinin

can cause edema coag system can stimulate its release

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

chicken wire appearance HAE - prodrome rash C1 esterase deficiency

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

acute intermittant porphyria -deficiency of phophobilinogen deaminase "porphyria"

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

familial mediterrean fever

IL-8 disease - overactive chronic - amyloid** - acute phase reactant WBC mobbing tissue spaces - pathergy

amyloid production

familial mediterranean fever die from kidney failure

45yo black M RUQ pain -tender and pedal edema CXR - cardiomyopathy EKG - hypercalcemia

hypercalcemia, sarcoidosis** -restrictive cardiomyopathy -high pulmonary pressures - with restrictive cardiomyopathy - can lead to liver congestion

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Abdominal Pain and Pancreatic DIsease CIS - Darrow Flashcards

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