Acute Pancreatitis

Question 0

Patients with mild right upper quadrant abdominal pain with heavy meals?

Answer 0

Biliary colic

Question 1

Diagnostic step for patients suspected pancreatitis from Cholelithiasis?

Answer 1

Right upper quadrant abdominal ultrasound

Question 2

Pancreatitis versus biliary colic pain?

Answer 2

Location of pain: radiating straight to the back vs RUQ

Accompanied by nausea and vomiting vs not

Question 3

Think severe pancreatitis with what initial signs?

Answer 3

WBC GALA
WBC >16,000
Glucose >200
LDH >350
AST > 250
Age >55

Question 4

Think severe pancreatitis with what signs 48 hours After admission?

Answer 4

BASH
BUN rise > 5 
Base deficit > 4
Arterial PO2 < 60
Serum calcium < 8
Hematocrit drops >10 points

Question 5

Pancreatic pseudocyst?

Answer 5

Cyst within the pancreas not lying by epithelial cells, associated with chronic pancreatitis

Question 6

Most common causes of pancreatitis in the US?

Answer 6

1. Alcohol especially following binge drinking

2. Biliary tract disease (gallstones)

Question 7

When is hypertriglyceridemia a cause of acute pancreatitis?

Answer 7

Levels are more than 1000

Question 8

When patients have no gallstones seen on ultrasound and no other predisposing factor likely cause of pancreatitis?

Answer 8

Biliary tract disease (biliary sludge, or sphincter of Oddi dysfunction)

Question 9

Biliary sludge a.k.a.?

Answer 9

Microlithiasis

Question 10

Acute pancreatitis: what makes pain better? What makes pain worse?

Answer 10

Sitting up and bending forward. Food.

Question 11

Three reasons acute pancreatitis patients are volume depleted?

Answer 11

1. Vomiting
2. No oral intake
3. Inflammatory process creates third spacing, sequestering large volumes of fluid in the peritoneal cavity

Question 12

Most common test to diagnose pancreatitis? Good for? Can also be elevated in?

More specific test?

Answer 12

Amylase level. Rises within hours and remains elevated for 3 to 4 days. GI Ischemia with infarction or perforation, vomiting

Serum lipase (remains elevated longer than amylase)

Question 13

Treatment of pancreatitis?

Answer 13

1. pancreatic rest (withholding food or liquids by mouth)
2. narcotic analgesia (with meperidine)
3. IV fluids

Question 14

One can oral liquid be restarted in patients with acute pancreatitis?

Answer 14

When the pain has largely subsided and the patient has bowel sounds

Question 15

Most common cause of death in patients with pancreatitis?

Answer 15

Hypovolemic shock

Question 16

Complications of pancreatitis? Tx?

Answer 16

Phlegmon - Solid mass of inflamed pancreas with areas of necrosis (can become secondarily infected resulting in pancreatic abscess). An abscess would need to get drained

Pancreatic pseudocyst (if they are smaller than 6 cm, thry usually resolve spontaneously)