Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Acute pancreatitis > Flashcards

Acute pancreatitis Flashcards

1
Q

What percentage of pancreatitis cases are mild to moderate?

A

70-85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pain like in acute pancreatitis?

A

steady and persistent for many hours. N/V

Pain is worse in the upper quadrants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What additional Sx will a pt with SEVERE acute pancreatitis have?

A 
Tachycardia
Mental status changes
Hypotension
Hypoxia
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Would the abdomen be rigid in pancreatitis?

A

NO–that’s a peritoneal sign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Grey-turner sign

A

ecchymosis in the flank region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cullen sign

A

ecchymosis in the periumbilical region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What other things could cause an elevated amylase besides pancreatitis?

A 
Cholecystitis
Bowel obstruction/perforation
Intestinal ischemia
Appendicitis
Ectopic pregnancy
Overian cysts
Lung cancer
Drugs
ERCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is the serum lipase more sensitive?

A

All lipase comes from the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What other labs might be abnormal

A

WBC high, esp in severe pancreatitis
Glucose and LFTs high if gallstones are present
Calcium low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What imaging tests might help?

A

Plain abdominal films excludes perforation and intestinal obstruction
Abdominal CT: shows inflammation of pancreas, extent of inflammation, and necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the downside to using a CT in suspected pancreatitis?

A

It may be normal in 15-30% of pts with mild pancreatitis won’t show early signs in CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What criteria are used to diagnose acute pancreatitis?

A
  1. Abdominal pain consistent with acute pancreas
  2. elevated amylase/lipase 3x normal limit
  3. confirmation with X-sect abd imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What’s your differential for pancreatitis?

A 
cholecystitis
cholangitis
perforation
mesenteric ischemia
intestinal obstruction

MI
aortic dissection
ectopic pregnancy
crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two most common causes of acute pancreatitis?

A

alcohol abuse and gallstones (these comprise 80% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Do gallstones lead to chronic pancreatitis?

A

No–while alcohol can cause permanent structural changes, intermittent obstruction of the pancreatic duct usually does not.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are less common causes of acute pancreatitis?

A 
idiopathic (10-15%)
Hereditary
Hyperparathyroidism/hypercalcemia
Cancer
medications
hepatitis
toxins (trinidadian scorpion)
ERCP
Trauma
Inherited
Pregnancy
17
Q

What are three inherited causes of acute pancreatitis?

A
  1. Trypsinogen mutation (loss of inactivation binding site)
  2. CFTR mutations: thickened mucus causes obstruction of bile duct, inaddition to malabsorption
  3. Familial hypertriglyceridemia
18
Q

How do you determine the severity of pancreatitis?

A

Use the ranson index, with 11 variables.

19
Q

What is missing from the ranson index?

A

amylase/lipase elevation! These are elevated both in acute and chronic cases and don’t tell you more than that.

20
Q

Aside from the ranson index, what other prognostic indicators are there?

A

BISAP>2

  • BUN>25
  • Impaired mental status
  • SIRS
  • Age>60
  • Pleural effusion
21
Q

What are early complications of severe acute pancreatitis?

A
  1. massive dehydration
  2. hyperglycemia, hypocalcemia, electrolyte abnormalities, coagulopathy and hypoxia
  3. SIRS
22
Q

What is SIRS?

A

Systemic inflammatory response syndrome: Fever, tachycardia, tachypnea, elevated WBC

23
Q

What are the late complications of acute pancreatitis?

A

Occurs after the 2nd week. Pseudocysts, abscesses, and GI hemorrhage
–>death from SIRS/sepsis/multiorgan failure. Can occur at any time.

24
Q

How do you treat sterile necrosis of the pancreas? Infected necrosis?

A
  1. Antibiotics, conservative

2. Antibiotics, debridement

25
Q

How do you treat GI hemorrhage?

A

Transfuse, PPI, surgery

26
Q

Why might pancreatitis cause a coagulopathy?

A

Circulating proteases

27
Q

Why might someone with pancreatitis get acute renal failure?

A

Hypotension, causing pre-renal or hemodynamic ARF

28
Q

How do you treat mild acute pancreatitis?

A

IV hydration
Nothing by mouth
Parenteral analgesia
Removal of risk factors (cholecystectomy or alcohol/medication removal)

29
Q

How do you treat severe acute pancreatitis?

A
  1. fluid/electrolyte replacement
  2. Pain control
  3. Nutrition thru a jejunal tube
  4. Antibiotics: ONLY if established infection
  5. Surgery: Drainage of symptomatic pseudocysts or debridement of infected necrosis
  6. Emergent ERCP is controversial for gallstone removal
30
Q

In gallstone pancreatitis, should you remove the gallstone after acute episode has resolved?

A

YES, because the recurrence rates are so high. Use cholecystectomy or ERCP prior to discharge.

GI (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions