acute and chronic pancreatitis (benson)

Question 1

Acute Pancreatitis pathophysiology

Answer 1

Acinar Cell Injury

Premature Trypsinogen to Trypsin

Autodigestion of Pancreas

Activation of Prekallikrein (Fletcher factor)- Edema, Inflammation
Activation of Phospholipase- Coagulation Necrosis
Activation of Lipase-Fat Necrosis
Activation of Elastase-Edema, Vascular Damage
Activation of Chymotrypsin- Edema, Vascular Damage

Question 2

Acute Pancreatitis diagnosis

Answer 2

clinical presentation- acute abdominal pain
lipase/ amylase x3 nul
CT: confirmatory edema around pancrease/ rule out other things (only if need reasurance)

Question 3

amylase elevation causes

Answer 3

Abdomen:

Small bowel obstruction
Acute appendicitis
Cholecystitis
Perforated duodenal ulcer
Gastroenteritis
Biliary peritonitis

GYN
Other (Parotitis, Macroamylasaemia, Opiod use)

Question 4

Acute Pancreatitis causes

Answer 4

i- idiopathic

g- gall stones
e-ethanl
t-trauma

s-steroids
m-mumps
a-autoimmune (IGG4)
s-scorpions 
h-hyperglacimia & hypertriglyceridemia
e-ERCP
d-drugs

Question 5

severity of acute pancreatitis

Answer 5

mild- absence of organ failure and local complications

moderatly severe- local complications and/or transient organ failure

severe -persistant organ failure

Question 6

managment of acute pancreatitis

Answer 6

aggresive fluid resuscitation in first 24h

oral feeding as soon as posible if managable/ enteral nutrition

antibiotics for infection

Question 7

local complications of acute pancreatitis

Answer 7

interstitial pancreatitis

necrotizing pancreatitis

Question 8

Interstitial edematous acute pancreatitis

Answer 8

Limited inflammation and swelling of the pancreatic parenchyma
Stranding
Perfusion is preserved
85% of acute pancreatitis cases

Question 9

Acute peripancreatic fluid collection (APFC)

Answer 9

Homogenous fluid adjacent to pancreas

No recognizable wall
within the first 4w of interstitial edematous acute pancreatitis
If sterile usually resolves

Question 10

Pancreatic pseudocyst

Answer 10

Well-circumscribed
homogenous fluid collection
well-defined wall 
only in interstitial edematous pancreatitis (after first 4w)
Treat only if symptomatic

Question 11

Acute necrotic collection (ANC)

Answer 11

Heterogenous, varying of non-liquid density
no wall
No air
diffuse or focal areas of nonviable pancreatic parenchyma

Occurs within the first 4 weeks of necrotizing pancreatitis, often with in first 4 days

Question 12

Walled-off necrosis (WON)

Answer 12

Heterogenous liquid and non-liquid density (necrosis)
Well-defined wall (the wall develops)
Usualy occurs > 4 weeks after necrotizing pancreatitis
mature phase of ANC

Question 13

Management of pancreatic fluid collections

Answer 13

EUS- stent placed on spincher of oddi

Question 14

Chronic Pancreatitis characteristics

Answer 14

Progressive
Irreversible fibrosis
Calcifications
Dilation of pancreatic duct

Question 15

Chronic Pancreatitis symptoms

Answer 15

Pain (obstruction)

Exocrine Insufficiency ->Malabsorption

Endocrine Insufficiency -> Diabetes

Question 16

Chronic Pancreatitis causes

Answer 16

TIGAR-O
toxic metabolic
idiopathic 
genetic 
autoimmune 
recurrent severe acute pancrititis
obstructive

Question 17

Chronic Pancreatitis symptoms

Answer 17

pain - epigastric with radiation to back

steatorrhea

Question 18

Assessing exocrine pancreatic insufficiency

Answer 18

Trial of enzyme supplementation
steatorrhea resovled?
probably secondary to pancreatitis