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gi exam 2 > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

How much alkaline fluid does the pancreas secrete?

A

1.5-3 L

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2
Q

What does the pancreas neutralize?

A

Acidic chyme

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3
Q

What are the 2 pancreatic enzymes? (Protein)

A
  1. Trypsin
  2. Chymotrypsin
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4
Q

What are the 2 pancreatic enzymes? (Lipids)

A
  1. Amylase
  2. Lipase
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5
Q

What does the pancreas do for glucose management?

A
  1. Insulin
  2. Glucagon
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6
Q

What does the pancreas release? 2 (hormonal)

A
  1. Secretin
  2. Cholecystokinin
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7
Q

What does secretin stimulate?

A

Ductal cells to secrete bicarbonate-rich fluid

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8
Q

what does CCK stimulate?

A

Acinar cells to secrete digestive enzymes

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9
Q

What is the most nervative organ other than the brain?

A

The pancreas

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10
Q

What laboratory marker is increased with inflammation and is non-specific?

A

Amylase

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11
Q

What laboratory marker is increased with inflammation and is more specific?

A

Lipase

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12
Q

What is the initial test used for diagnosis of pancreatitis?

A

X-ray

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13
Q

What diagnostic test focuses on edema, inflammation, and calcification and masses?

A

Ultrasound

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14
Q

What diagnostic test is able to visualize necrosis and fluid collections?

A

CT Scan with contrast

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15
Q

What is the gold standard test to diagnose diagnosis?

A

CT Scan with contrast

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16
Q

What diagnostic test has the best imaging?

A

Magnetic resonance chloangiopacreatography (MRCP)

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17
Q

What does acute pancreatitis lead to?

A

Inflammation

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18
Q

What does chronic pancreatitis lead to?

A

Fibrosis

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19
Q

There is a low mortality in pancreatitis unless it’s what type of pancreatitis?

A

Infectious pancreatitis

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20
Q

Unregulated activation of trypsin from trypsinogen

A

Auto digestion

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21
Q

What activates the complement and kinin pathways?

A

Inflammation

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22
Q

What should you check for when inflammation arises with pancreatitis?

A

Tuberculosis reactivation

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23
Q

What is the #1 cause of obstructive pancreatitis?

A

Gallstones

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24
Q

What are three causes of obstructive pancreatitis?

A
  1. Gallstones
  2. Duodenal obstruction
  3. Crohn’s disease
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25
Q

What are 3 direct toxicities that could lead to pancreatitis?

A
  1. Alcohol
  2. Medications
  3. Scorpion bite
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26
Q

Increased ductal pressure leading to the activation of pancreatic enzymes

A

Obstructive pancreatitis

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27
Q

What is obstructive pancreatitis often accompanied by?

A

LFT elevation

28
Q

What patient population is biliary sludging common in?

A

Pediatrics

29
Q

What 4 disease states can cause obstructive pancreatitis?

A
  1. Gallstones
  2. Biliary sludging
  3. Tumors
  4. Crohns Disease
30
Q

What is another cause of toxic pancreatitis?

A

Insecticide exposure

31
Q

What 5 drugs can cause pancreatitis?

A
  1. Statins
  2. Oral contraceptives
  3. HAART therapy
  4. Valproic acid
  5. ACE Inhibitors
32
Q

What metabolic complication can cause pancreatitis?

A

Hyperlipidemia

33
Q

What are 4 other causes of pancreatitis?

A
  1. Infections
  2. Metabolic
  3. Autoimmune
  4. Pregnancy
34
Q

Where and how does pain present in pancreatitis? 3

A
  1. Epigastric area and the right upper quadrant
  2. Often radiating to the back
  3. Often severe and lasts for days
35
Q

What are 4 frequent symptoms from the pain experienced from pancreatitis?

A
  1. Nausea
  2. Emesis
  3. Fever
  4. Tachycardia
36
Q

What are 3 severe symptoms caused by the pain in pancreatitis?

A
  1. Leukocytosis
  2. Hypocalcemia
  3. Hyperglycemia
37
Q

Pancreatic necrosis into the retroperitoneum

A

Cullen’s sign

38
Q

What are 3 of the things that need to be required for diagnosis? (Only 2 out of the 3 needed)

A
  1. Typical abdominal pain
  2. Three fold or greater elevation in serum amylase and/or lipase
  3. CT Scan showing inflammation of the pancreas
39
Q

What’s the classification?: Organ failure is Absent

A

Mild

40
Q

What’s the classification?: Organ failure is Transient <48 hours

A

Moderate

41
Q

What’s the classification?: Organ failure is Persistent
<48 hours

A

Severe

42
Q

What’s the classification?: Local and Systemic complications are Absent

A

Mild

43
Q

What’s the classification?: Local or Systemic complications are present

A

Moderate or Severe

44
Q

What can local or systemic complications lead to?

A

Necrosis and elevated WBC

45
Q

What marker of severity is associated with mild acute pancreatitis?

A

Hemo-concentration (Hct >44)

46
Q

What marker of severity is associated with moderate pancreatitis?

A

Azotemia

47
Q

What marker of severity is a sign of severe pancreatitis?

A

Signs of organ failure

48
Q

When should you begin treatment if infection is identified?

A

If CT shows “walled off area” near necrotic tissue

49
Q

What 3 things are used to treat mild to moderate disease?

A
  1. Fluid resuscitation
  2. Hold nutrition until able to tolerate
  3. Pain management and anti-emetic therapies
50
Q

What 3 things are used for severe disease management?

A
  1. Fluid resuscitation
  2. Enteral feeding
  3. Management of necrosis
51
Q

What 2 fluids can be used for fluid resuscitation?

A
  1. Lactated ringers (best)
  2. Normal saline
52
Q

What is the goal with fluid resuscitation?

A

Reduce HR to <120 bpm

53
Q

What is often initial therapy for pain management in pancreatitis?

A

Opioids

54
Q

What should be given if a patient is given opioids?

A

Stimulant laxatives

55
Q

What are 2 complications that can be seen if a patient is restricted from nutrition?

A
  1. Increased intestinal mucosal atrophy
  2. Infectious complications due to bacterial translocation from the gut
56
Q

In severe cases, when should enteral nutrition be started?

A

Within 24-48 hours

57
Q

How long should you withhold nutrition in mild pancreatitis?

A

Until the patient can tolerate oral intake (goal within 48 hours)

58
Q

You should restart nutrition ______ when the patient can tolerate

A

Gradually

59
Q

When do infections usually develop?

A

During the 2nd or 3rd week

60
Q

What is the leading cause of morbidity and mortality with pancreatitis?

A

Infections

61
Q

True or False: antibiotic prophylaxis is recommended

A

False

62
Q

When can antibiotic prophylaxis be used?

A
  1. When infection is suspected
  2. Walled off area surrounding necrosis
63
Q

What are 2 empiric antibiotics that can be used?

A
  1. Imipenem
  2. Meropenem
64
Q

How long would you treat with empiric antibiotics?

A

14 days

65
Q

What 4 things would help to prevent future pancreatitis flares?

A
  1. Avoiding alcohol
  2. Maintain appropriate TG level
  3. Change to medications with less incidence of causing pancreatitis
  4. Avoid ‘trigger’ foods

gi exam 2 (11 decks)

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