Acute Pancreatitis Flashcards
90%
caused by
alcoholism and cholelithiasis.
Less common causes of acute pancreatitis include
Trauma. hydrochlorothiazide)
Cx Fx
Acute epigastric pain worst when leaning back + tenderness + nausea/vomiting
if severe:hypotension and fever.
Which test results are associated with a worst prognosis
Low calcium. and
Disease severity strongly correlates with the degree of necrosis seen on CT scanning.
best initial tests
amylase and** lipase (x3t the normal).** this is more sens esp
most specific test
CT scan + IV +PO contras
can also do MRI
tho lipase can be enough
NO US NO US
what to do if extensive necrosis.
CT scan guided Needle biopsy + gram stain and culture*** Only way to determine infection
more than __% determines an extensive necrosis
> 30%
CBC: shows
Leukocytosis, drop in hematocrit over time with rehydration
How do this lab tests look like in Pancreatitis: LDH AST O2 Ca++ urinary trypsinogen activation peptide
Elevated LDH and AST
Hypoxia, hypocalcemia
Elevated urinary trypsinogen activation peptide
how to determine etiology
Magnetic resonance cholangiopancreatography (MRCP): (stones, stricture,tumor).
ERCP is for therapy.
US can see gallsotnes xD
x-ray shows
sentinel loop of bowel (air-filled piece of small bowel in
left upper quadrant).
Tx
NPO (no food)
IV hydration at very high volume (cristaloids)
Analgesia
PPIs decrease pancreatic stimulation from acid entering the duodenum
Amboss: Begin enteral feeding (oral/nasogastric/nasojejunal) as soon as the pain subsides
Tx if >30% necrosis on CT or MRI,
adding antibiotics such as
imipenem or meropenem
Infected, necrotic pancreatitis Tx
resected with surgical
debridement to prevent ARDS and
death.
