acute pancreatitis

Question 1

Acute pancreatitis - MCC

Answer 1

90% caused by alcoholism + cholelithiasis

Question 2

Acute pancreatitis - etiology

Answer 2

I GET SMASHED 
Idiopathic 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune 
Scorpion sting
Hypercalcemia/hypertriglyceridemia
ERCP
Drugs 
\+ cystic fibrosis, ductal obstruction

Question 3

Acute pancreatitis - drugs as a cause

Answer 3

drug toxicity: pentamidine, didanosine, azathioprine, estrogen
drug allergy: sulfa such as furosemide, hydrochlorothiazide

Question 4

Acute pancreatitis - presentation

Answer 4

acute epigastric pain + tenderness + nausea/vomiting

in severe cases there is hypotension + fever

Question 5

pain - acute pancreatitis vs cholecystitis

Answer 5

pancreatitis - straight through the back like a spear stabbed into the abdomen
cholecystitis - goes around the side to the back

Question 6

lab - the worst prognosis for acute pancreatitis

Answer 6

low calcium

Question 7

acute pancreatitis - lipase + amylase prognosis

Answer 7

both elevated, but there is no correlation between the height of these enzyme levels and disease severity

Question 8

acute pancreatitis - CRP prognosis

Answer 8

CRP has never been shown definite corelation with severity in any disease

Question 9

acute pancreatitis - best initial test

Answer 9

amylase + lipase

Question 10

acute pancreatitis - most specific test

Answer 10

CT scan

Question 11

amylase vs lipase in acute pancreatitis regarding specificity

Answer 11

lipase is more specific

Question 12

acute pancreatitis - beside Ca, desease severity is also correlates with the

Answer 12

degree of necrosis seen on CT

greater than 30% –> extensive necrosis

Question 13

acute pancreatitis - extensive necrosis - additional test

Answer 13

needle biopsy is indispensible in determining the presence of infection in those who have extensive necrosis

Question 14

acute pancreatitis - lab tests

Answer 14

1. CBC: leukocytosis, drop in HCT over tume with rehydration
2. elevated LDH + AST
3. Hypoxia, hypocalcemia
4. elevated urinary trypsinogen activation peptide

Question 15

acute pancreatitis imaging - only the names

Answer 15

1. CT or MRI
2. MRCP / ERCP
3. Plain x ray
4. US

Question 16

acute pancreatitis imaging - CT or MRI

Answer 16

best –> also detects pseydocysts

Question 17

acute pancreatitis imaging - MRCP / ERCP

Answer 17

MRCP is useful determining the etiology of the disease (diagnostic)
ERCP is for therapy

Question 18

acute pancreatitis imaging - Plain X-ray

Answer 18

sentinel loop of bowel (air filled piece of small bowel in LUQ

Question 19

acute pancreatitis imaging - US

Answer 19

very poor accuracy

overlying bowel blocks precise imaging

Question 20

acute pancreatitis - treatment

Answer 20

1. NPO
2. IV hydration at very high volume
3. analgesia
4. PPIs
5. +/- antibiotcs

Question 21

acute pancreatitis - treatment - PPIs?

Answer 21

decrease pancreatic stimulation from acid entering the duodenum

Question 22

acute pancreatitis - treatment - antibiotics?

Answer 22

if there is more than 30% necrosis on CT or MRI, adding antibiotics such as imipenem or meropenem may decrease mortality by development of infected necrotic pancreatitis

Question 23

acute pancreatitis - treatment - surgery

Answer 23

infected, necrotic pancreatitis should be resected with surgical debridement to prevent ARDS + Death

Question 24

Psuedocysts - management

Answer 24

drained with a needle if they are enlarged or painful

Question 25

acute pancreatitis - ERCP is used to

Answer 25

1. remove obstructing stones and dilate strictures

2. place stent