acute pancreatitis

Question 1

definition

Answer 1

sudden inflammation and hemorrhaging of the pancreas dt destruction by its own digestive enzymes

Question 2

causes

Answer 2

etoh and gallstones
inj to acinar cells
impaired secretion of proenzymes

Question 3

etoh causes

Answer 3

increases secretion from the acinar cells while decreasing fluid and bicarbonate production.
results: thick pancreatic juices that block duct
pressure inside duct increases causes distention and autodigestion
stimulates release of cytokines which causes an immune rxn

Question 4

gallstone caused

Answer 4

lodged in sphincter of oddi causing blockage then same as ETOH

Question 5

other causes

Answer 5

IGETSMASHED
idiopathic
gallstones
ethanol abuse
trauma
steroids
mumps
autoimmune
scorpion stings
hypertriglyceridemia/hypercalcemia
ERCP 
DRugs

Question 6

S&S

Answer 6

N/V
intense pain in epigastric region radiating to back
loss of appetite
palpable mass
hypocalcemia
jaundice
Cullen signs: periumbilical bruise
grey turner sign: bruise to flank

Question 7

tests

Answer 7

lab: increased amylase
increased lipase
ct: inflammation/necrosis
US: gallstones

Question 8

anylase or liapase may be elevated for these other reasons

Answer 8

high intestinal obstruction, gastroenteritis, mumps not involving pancreas
, ectopic preg, after opioids and/or sx

Question 9

complications

Answer 9

fluid leak in pacreatic bed and ileus w/ fluid filled loops of bowel=hypovolemia and pre-renal azotemia+ATN
Necrosis: fever, leukocytosis, shock= AKI
ARDS 3-7 days after onset, dt large fluid volumes+ intubation
pancreatic abscess: 6 weeks into course:
pseudocyst
ascities

Question 10

tx for mild

Answer 10

admit, npo, br, ng tube, ivf, pain control, advanced diet as tolerated
all mild therapy:
large ivf vol, hemodynamic monitoring, stabilize bp, hr, cvp, treat hypocalcemia, coagulopathy, enteral nutrition, abx

Question 11

tx of severe

Answer 11

ICU