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GI > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What does the pancreas do?

A
  1. neutralizes acidic chyme (secretes 1.5-3L of alkaline fluid daily
  2. digestion of proteins (trypsin, chymotrypsin) and fats (amylase, lipase)
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2
Q

How does the pancreas manage glucose levels?

A

releases insulin when blood glucose is too high;
releases glucagon when blood glucose is too low

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3
Q

How does the pancreas manage hormones?

A
  1. secretin stimulates ductal cells to secrete bicarb-rich fluid
  2. cholecystokinin (CCK) stimulates acinar cells to secrete digestive enzymes
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4
Q

What type of neural control does the pancreas have?

A

autonomic innervation (parasympathetic and sympathetic nerve fibers)

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5
Q

What enzymes are increased with inflammation and have a non-specific pathology?

A

Amylase
Lipase

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6
Q

Why is an x-ray the initial test for acute pancreatitis?

A

pancreas looks abnormal in acute and chronic pancreatitis

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7
Q

What can an ultrasound of the pancreas show?

A
  1. edema
  2. inflammation
  3. calcification
  4. masses
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8
Q

What can a CT scan with contrast show?

A

visualizes necrosis and fluid collections

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9
Q

What can an MRCP show?

A

3-D view of necrosis and fluid collections
(best imaging)

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10
Q

What is the difference between acute and chronic pancreatitis?

A

acute- inflammation
chronic- fibrosis

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11
Q

What is the cause of acute pancreatitis?

A
  1. autodigestion (unregulated activation of trypsin)
  2. inflammation (activated complement and kinin pathways)
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12
Q

What is the most common cause of acute pancreatitis?

A

Obstruction
1. Gallstones
2. duodenal obstruction
3. chron’s

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13
Q

What toxins can cause acute pancreatitis?

A
  1. alcohol
  2. medications
  3. scorpion bite
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14
Q

Why does obstruction cause pancreatitis?

A

increased ductal pressure leads to the activation of pancreatic enzymes

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15
Q

What antibiotic can cause biliary sludging?

A

Ceftriaxone

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16
Q

What is the number 1 cause of toxic pancreatitis?

A

alcohol

17
Q

What drugs can induce acute pancreatitis?

A
  1. statins (rosuvastatin)
  2. ACE (-)
  3. oral contraceptives
  4. Diuretics (loop)
  5. HIV HAART therapy
  6. Valproic acid
18
Q

What are other causes of acute pancreatitis?

A
  1. infections
  2. triglyceridemia >500
  3. autoimmune
  4. pregnancy
19
Q

How does pain present in acute pancreatitis?

A

constant in the epigastric area and right upper quadrant; can radiate to the back; lasts days

20
Q

What are the symptoms of acute pancreatitis?

A

nausea
emesis
fever
tachycardia
leukocytosis
hypocalcemia
hyperglycemia

21
Q

What is a bruise that shows pancreatic necrosis into the retroperitoneum?

A

cullen’s sign

22
Q

What is required for diagnosis?

A

2/3 required:
1. abdominal pain
2. 3x elevation in serum amylase/ lipase
3. CT scan showing inflammation

23
Q

When should treatment of infection begin?

A

If CT scan shows “walled off area”/ puss pocket near necrotic tissue

24
Q

How is mild acute pancreatitis classified?

A
  1. organ failure absent
  2. local and systemic complications absent
  3. Hct > 44%
25
Q

How is moderate acute pancreatitis classified?

A
  1. organ failure transient <48 h
  2. local/ systemic symptoms present
  3. BUN >22
26
Q

How is severe acute pancreatitis classified?

A
  1. organ failure persistent >48h
  2. local/systemic symptoms present
  3. signs of organ failure (BP <90, HR >130, SCr 1.5x baseline)
27
Q

How are mild and moderate acute pancreatitis managed?

A
  1. fluid resuscitation
  2. NPO until tolerated
  3. pain management
  4. anti-emetic therapies
28
Q

How is severe acute pancreatitis managed?

A
  1. fluid resuscitation
  2. enteral feeding
  3. management of necrosis
29
Q

What agent is preferred for fluid resuscitation?

A

Lactated ringers or normal saline 5-10 ml/kg/hr

30
Q

What is the goal of fluid resuscitation?

A

reduce HR <120

31
Q

What agents are initially used for pain management?

A

opioids + stimulant laxatives

32
Q

What issues can occur when a patient is NPO?

A
  1. increased intestinal mucosal atrophy
  2. infectious complications due to bacterial translocation in the gut
33
Q

How long will someone with severe acute pancreatitis get nutrition through nasoenteric feeding?

A

24-48 hours

34
Q

How long should nutrition be withheld in mild pancreatitis?

A

within 48 hours until patient can tolerate oral intake; restart gradually

35
Q

Is antibiotic prophylaxis recommended to prevent infectious pancreatitis?

A

No

36
Q

What bacteria are potential causes of infection?

A

GM-: E.coli, Kleb, pneumonia, pseudamonis. proteus mirabilis
GM+: enterococcus, streptococcus

37
Q

What is the empiric treatment for pancreatic infection?

A

Imipenem or Meropenem for 14 days

38
Q

How are future flares prevented?

A
  1. avoid alcohol
  2. maintain triglyceride level
  3. change to medications with less incidence of pancreatitis
  4. avoid trigger foods

GI (23 decks)

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