Acute Pancreatitis Flashcards
How much alkaline fluid does the pancreas secrete?
1.5-3 L
What does the pancreas neutralize?
Acidic chyme
What are the 2 pancreatic enzymes? (Protein)
- Trypsin
- Chymotrypsin
What are the 2 pancreatic enzymes? (Lipids)
- Amylase
- Lipase
What does the pancreas do for glucose management?
- Insulin
- Glucagon
What does the pancreas release? 2 (hormonal)
- Secretin
- Cholecystokinin
What does secretin stimulate?
Ductal cells to secrete bicarbonate-rich fluid
what does CCK stimulate?
Acinar cells to secrete digestive enzymes
What is the most nervative organ other than the brain?
The pancreas
What laboratory marker is increased with inflammation and is non-specific?
Amylase
What laboratory marker is increased with inflammation and is more specific?
Lipase
What is the initial test used for diagnosis of pancreatitis?
X-ray
What diagnostic test focuses on edema, inflammation, and calcification and masses?
Ultrasound
What diagnostic test is able to visualize necrosis and fluid collections?
CT Scan with contrast
What is the gold standard test to diagnose diagnosis?
CT Scan with contrast
What diagnostic test has the best imaging?
Magnetic resonance chloangiopacreatography (MRCP)
What does acute pancreatitis lead to?
Inflammation
What does chronic pancreatitis lead to?
Fibrosis
There is a low mortality in pancreatitis unless it’s what type of pancreatitis?
Infectious pancreatitis
Unregulated activation of trypsin from trypsinogen
Auto digestion
What activates the complement and kinin pathways?
Inflammation
What should you check for when inflammation arises with pancreatitis?
Tuberculosis reactivation
What is the #1 cause of obstructive pancreatitis?
Gallstones
What are three causes of obstructive pancreatitis?
- Gallstones
- Duodenal obstruction
- Crohn’s disease
What are 3 direct toxicities that could lead to pancreatitis?
- Alcohol
- Medications
- Scorpion bite
Increased ductal pressure leading to the activation of pancreatic enzymes
Obstructive pancreatitis
What is obstructive pancreatitis often accompanied by?
LFT elevation
What patient population is biliary sludging common in?
Pediatrics
What 4 disease states can cause obstructive pancreatitis?
- Gallstones
- Biliary sludging
- Tumors
- Crohns Disease
What is another cause of toxic pancreatitis?
Insecticide exposure
What 5 drugs can cause pancreatitis?
- Statins
- Oral contraceptives
- HAART therapy
- Valproic acid
- ACE Inhibitors
What metabolic complication can cause pancreatitis?
Hyperlipidemia
What are 4 other causes of pancreatitis?
- Infections
- Metabolic
- Autoimmune
- Pregnancy
Where and how does pain present in pancreatitis? 3
- Epigastric area and the right upper quadrant
- Often radiating to the back
- Often severe and lasts for days
What are 4 frequent symptoms from the pain experienced from pancreatitis?
- Nausea
- Emesis
- Fever
- Tachycardia
What are 3 severe symptoms caused by the pain in pancreatitis?
- Leukocytosis
- Hypocalcemia
- Hyperglycemia
Pancreatic necrosis into the retroperitoneum
Cullen’s sign
What are 3 of the things that need to be required for diagnosis? (Only 2 out of the 3 needed)
- Typical abdominal pain
- Three fold or greater elevation in serum amylase and/or lipase
- CT Scan showing inflammation of the pancreas
What’s the classification?: Organ failure is Absent
Mild
What’s the classification?: Organ failure is Transient <48 hours
Moderate
What’s the classification?: Organ failure is Persistent
<48 hours
Severe
What’s the classification?: Local and Systemic complications are Absent
Mild
What’s the classification?: Local or Systemic complications are present
Moderate or Severe
What can local or systemic complications lead to?
Necrosis and elevated WBC
What marker of severity is associated with mild acute pancreatitis?
Hemo-concentration (Hct >44)
What marker of severity is associated with moderate pancreatitis?
Azotemia
What marker of severity is a sign of severe pancreatitis?
Signs of organ failure
When should you begin treatment if infection is identified?
If CT shows “walled off area” near necrotic tissue
What 3 things are used to treat mild to moderate disease?
- Fluid resuscitation
- Hold nutrition until able to tolerate
- Pain management and anti-emetic therapies
What 3 things are used for severe disease management?
- Fluid resuscitation
- Enteral feeding
- Management of necrosis
What 2 fluids can be used for fluid resuscitation?
- Lactated ringers (best)
- Normal saline
What is the goal with fluid resuscitation?
Reduce HR to <120 bpm
What is often initial therapy for pain management in pancreatitis?
Opioids
What should be given if a patient is given opioids?
Stimulant laxatives
What are 2 complications that can be seen if a patient is restricted from nutrition?
- Increased intestinal mucosal atrophy
- Infectious complications due to bacterial translocation from the gut
In severe cases, when should enteral nutrition be started?
Within 24-48 hours
How long should you withhold nutrition in mild pancreatitis?
Until the patient can tolerate oral intake (goal within 48 hours)
You should restart nutrition ______ when the patient can tolerate
Gradually
When do infections usually develop?
During the 2nd or 3rd week
What is the leading cause of morbidity and mortality with pancreatitis?
Infections
True or False: antibiotic prophylaxis is recommended
False
When can antibiotic prophylaxis be used?
- When infection is suspected
- Walled off area surrounding necrosis
What are 2 empiric antibiotics that can be used?
- Imipenem
- Meropenem
How long would you treat with empiric antibiotics?
14 days
What 4 things would help to prevent future pancreatitis flares?
- Avoiding alcohol
- Maintain appropriate TG level
- Change to medications with less incidence of causing pancreatitis
- Avoid ‘trigger’ foods
