Acute Pancreatitis Flashcards
amylase and lipase elevation pattern
The serum amylase level is almost always elevated
early on (> 3xN is almost always due to pancreatitis), but decreases
within 2-3 days after disease onset. The lipase level
increases later and stays elevated longer than the amylase at 7-14 days.
in which condition amylase level can be normal in acute pancreatitis?
Hyperlriglyceridemia
What levels of serum and urine amylase are specific for acute pancreatitis?
Very elevated serum or urine amylase levels, > 900 V/L and > 6000 V/L, respectively, are very specific indicators of acute pancreatitis (97%), but they have low sensitivity (50-70%)
considered severe if ~ 30% of the pancreas is necrotic
The severity of The acute pancreatitis is thought to be a direct result of
the degree of pancreatic necrosis and whether it is infected or not
How is pancreatic necrosis best diagnosed?
dynamic CT scan
What physical findings reflect severe pancreatic necrosis?
- heart : systolic BP < 90 mmHg; tachycardia > 130 bpm
- lungs: PO2 < 60 mmHg
- renal:progressive azotemia or oliguria < 50 mL/hr
- CNS == altered sensorium
- metabolic == low calcium < 8 mg/dL) and albumin < 3.2 g/dL
- hemoconcentration
Two factors indicate that a patient is more likely to have severe pancreatitis:
I) overweight with a BMI > 25 (especially if obese with BMI of > 29)
2) hemoconcentration with Hct> 50%(men) and>44% (women). This is a very important marker It not only predicts more severe pancreatitis but also is a marker for multiple organ failure. Follow serial Hct q 6 hours and if it is increasing or greater than these values, hydrate vigorously
What is the first test in the workup of the etiology of
acute pancreatitis ?
gallbladder ultrasound
If the amylase is still elevated after 10 days of therapy
think of something else going on, such as a (leaking?) pseudocyst or disrupted main pancreatic duct.
Recurrent acute pancreatitis with no evidence of gallstones or alcohol abuse
may be due to microlithiasis: thus, consider an elective cholecystectomy.
Gastric varices in thc absence of esophageal varices
occur only in splenic vein thrombosis, which is a complication of both severe acute pancreatitis and chronic pancreatitis.
when to perform ERCP in pancreatitis?
ERCP is not done acutely unless a patient has cholangitis and sepsis. Use ERCP after the acute period to exclude or treat any suspected common duct stones (e.g., the bilirubin is >2.5 or the ultrasound shows a dilated common duct).
Criteria for resumption of oral feeds in acute pancreatitis
- bowel sounds present and passing flatus/stools
- not requiring narcotics
- patient expresses hunger
What conditions can cause abdominal pain with an elevated amylase?
Acute pancreatitis, acute cholecystitis,intestinal infarction,diabetic ketoacidosis,perforated ulcer, salpingitis, and ectopic pregnancy! Other causes of hyperamylascmia are increased salivary amylase and macroamylasemia (a benign condition due to a low urinary excretion of amylase ).
