Adams: Pancreatis

Question 1

What is the most common cause of pancreatitis?

Answer 1

Alcohol (70%)

Question 2

How does alcohol cause pancreatitis?

Answer 2

It has a direct toxic affect on the liver.

Question 3

How does cholelithiasis cause pancreatitis?

Answer 3

STONES lodge in pancreatic duct or ampulla of Vater and cause an obstruction and subsequent extravasation of enzymes into the parenchyma.

Question 4

What are other common causes of pancreatitis?

Answer 4

Elevated triglycerides >1000 mg/dl (treat that first before you treat anything else)

Question 5

What is the pathophysiology of pancreatitis?

Answer 5

ACUTE EDEMATOUS PANCREATITIS= parenchymal edema and peripancreatic fat necrosis occurs first

When necrosis involves the parenchyma along w/ hemorrhage and gland dysfunction it is described as HEMORRHAGIC OR NECROTIZING PANCREATITIS.

Question 6

What are the sxs of pancreatitis?

Answer 6

Mid-epigastric pain (95%)
Severe
Moderately rapid onset (~30 minutes)
Progressive & constant
Can radiate to the back (50%)
Nausea / vomiting (60-80%)

Question 7

What is seen on physical exam for pancreatitis?

Answer 7

Appear ill, holding abdomen and likely to be moving around – unable to get comfortable

Tender epigastrium

Question 8

What is Gray Turner Sign and Cullens sign?

Answer 8

Gray Turner sign (flank ecchymosis) and Cullen’s sign (periumbilical ecchymosis) are UNCOMMON but classically described findings with severe hemorrhagic pancreatitis caused by leaking retroperitoneal blood.

Question 9

What lab tests are indicative of pancreatitis?

Answer 9

LIPASE IS BOTH MORE SENSITIVE AND SPECIFIC THAN AMYLASE (30% of the time it can be normal)

Increased WBC/glucose
Dehydration
Increased LDH and AST
decreased Ca/albumin/O2

CRP >15mg/dl 48 hours after symptom onset indicates increased severity

Question 10

What is the value of Ranson’s Criteria?

Answer 10

predict mortality after 48 hrs

Question 11

How is an abdominal CT useful in detecting pancreatitis?

Answer 11

85-95% accuracy for detection of necrosis

Pancreas and edema surrounding pancreas

Question 12

What is classically seen on an x-ray of a pt w/ pancreatitis?

Answer 12

SENTINEL LOOP (not commonly present but is clasic for pancreatitis)

Question 13

How do you treat pancreatitis?

Answer 13

IV HYDRATION (urine output >30-cc/hr)
NPO (don't feed them)
PAIN CONTROL (any narcotic--morphine, fentanyl)

Question 14

What are treatable causes of pancreatitis?

Answer 14

Medication
Cholelithiasis
Elevated Ca

Question 15

What is the course of acute pancreatitis?

Answer 15

Typically improves in 3-7 days
-decreased pain and lipase level, improved vital signs

ABSCESS OCCURS WHEN THERE IS BACTERIAL SEEDING IN NECROTIZING PANCREATITIS

Question 16

What is chronic pancreatitis?

Answer 16

Chronic calcifying pancreatitis

Protein plugs and calcifications–> atrophy and fibrosis

Question 17

What are common causes of chronic pancreatitis? (similar to acute)

Answer 17

ETOH (BY FAR THE MOST COMMON CAUSE)
Hypertriglyceridemia
Obstructive
Autoimmune
Trauma

Question 18

What are typical findings of chronic pancreatitis?

Answer 18

LIPASE AND AMYLASE MAY OFTEN BE NORMAL OR SLIGHTLY ELEVATED

dull epigastric pain that radiates to back
diarrhea (not metabolizing all their food)
weight loss
diabetes (destruction of pancreas)

Question 19

How do you treat chronic pancreatitis?

Answer 19

Enzyme supplements

Reduce fat intake

Question 20

What complications are associated with pancreatitis?

Answer 20

Ascites
Pancreatic pseudocyst
Diabetes, malabsorption, vit malabsorbtion

Question 21

When is pancreatic cancer usually diagnosed? What is the rate of survival?

Answer 21

USUALLY DIAGNOSED LATE W/ SXS OFTEN NONSPECIFIC: weight loss, visceral abdominal pain, jaundice

5 YEARS SURVIVAL RATE OF <5%