acute pancreatitis Flashcards
what is the pathology associated with acute pancreatitis ?
liquefactive necrosis and hemorrhage
what is the classic presentation of acute pancreatitis ?
epigastric pain
nausea and vomiting
what are the clinical findings associated with acute pancreatitis ?
cullen sign
grey turner sign
what is trypsin originally secreted as ?
secreted as trypsinogen and activated by enterokinases
trypsin activates all the other protein enzymes
what enzymes are measured for the diagnosis of pancreatitis ?
amylase
lipase ( more specific)
what is the most common cause of acute pancreatitis ?
gall stones
what are the causes of acute pancreatitis ?
I GET SMASHED
idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion sting
hypercalcemia
ERCP
Drugs
what is the criteria for the diagnosis of acute pancreatitis ?
1- acute epigastric pain radiating to the back
2- serum amylase or lipase to 3 times the upper limit
3- characteristic imaging findings
what kind of trauma is associated with pancreatitis ?
seatbelt trauma in children
what drugs are associated with causing pancreatitis ?
GLP-1 agonists ( exenatide, liraglutide)
sulfa drugs
6 MP
what feature is seen in autoimmune pancreatitis ?
igG4 plasma cells are a marker for the diease
serum IgG4 levels are elevated
Why does hypercalcemia cause pancreatitis ?
causes the actibvation of trypsin
why does hypertriglyceridemia ?
chylomicrons levels
how do duodenal ulcers cause pancreatitis ?
rupture of duodenal ulcers may cause pancreatitis
especially if posteriorly
what is the treatment of acute pancreatitis ?
NPO
IV fluids
Pain control
what is one of the systemic complications associated with pancreatitis ?
SIRS - dysregulated systemic inflammation
high temperature
high heart rate
high RR
high WBC count
SIRS in pancreatitis indicates severe sepsis
what criteria is used to asses the severity of acute pancreatitis ?
Ransons criteria
APACHE II
what are the complications of acute pancreatitis ?
DIC
ARDS
pancreatic pseudocyst
pancreatic abscess
fat necrosis
what are the criteria for diagnosis of DIC ?
prolonged PT/PTT
thrombocytopenia
vascular occlusion
what is ARDS ?
acute respiratory distress syndrome
damage to the capillary endothelium
looks like pulmonary edema but the wedge pressure is normal
what is the presentation of a pancreatic pseudocyst ?
lacks an epithelium
only covered by granulomatous tissue
the granulomatous tissue takes 4 weeks to develop
what is the most common location of a pseudocyst ?
most common location is the lesser sac , posterior to the stomach
what is the feared outocme of a large pseudocyst ?
rupture which may cause peritonitis
what are the features of a pancreatic abscess ?
infected pancreatic pseudocyst
usually caused by intestinal bacteria _ E.coli
what is fat necrosis and what are the features or results of it ?
inflammation of the fat surrounding the pancreas
can lead to hypocalcemia or hypomagnesemia
what is saponification
chemical reaction where fat mixes with calcium to form soap-like deposits
depletes calcium from the blood - hypocalcemia
bad prognosis for acute pancreatitis
