Adams: Pancreatis Flashcards
What is the most common cause of pancreatitis?
Alcohol (70%)
How does alcohol cause pancreatitis?
It has a direct toxic affect on the liver.
How does cholelithiasis cause pancreatitis?
STONES lodge in pancreatic duct or ampulla of Vater and cause an obstruction and subsequent extravasation of enzymes into the parenchyma.
What are other common causes of pancreatitis?
Elevated triglycerides >1000 mg/dl (treat that first before you treat anything else)
What is the pathophysiology of pancreatitis?
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.
What are the sxs of pancreatitis?
Mid-epigastric pain (95%) Severe Moderately rapid onset (~30 minutes) Progressive & constant Can radiate to the back (50%) Nausea / vomiting (60-80%)
What is seen on physical exam for pancreatitis?
Appear ill, holding abdomen and likely to be moving around – unable to get comfortable
Tender epigastrium
What is Gray Turner Sign and Cullens sign?
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.
What lab tests are indicative of pancreatitis?
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
What is the value of Ranson’s Criteria?
predict mortality after 48 hrs
How is an abdominal CT useful in detecting pancreatitis?
85-95% accuracy for detection of necrosis
Pancreas and edema surrounding pancreas
What is classically seen on an x-ray of a pt w/ pancreatitis?
SENTINEL LOOP (not commonly present but is clasic for pancreatitis)
How do you treat pancreatitis?
IV HYDRATION (urine output >30-cc/hr) NPO (don't feed them) PAIN CONTROL (any narcotic--morphine, fentanyl)
What are treatable causes of pancreatitis?
Medication
Cholelithiasis
Elevated Ca
What is the course of acute pancreatitis?
Typically improves in 3-7 days
-decreased pain and lipase level, improved vital signs
ABSCESS OCCURS WHEN THERE IS BACTERIAL SEEDING IN NECROTIZING PANCREATITIS
What is chronic pancreatitis?
Chronic calcifying pancreatitis
Protein plugs and calcifications–> atrophy and fibrosis
What are common causes of chronic pancreatitis? (similar to acute)
ETOH (BY FAR THE MOST COMMON CAUSE) Hypertriglyceridemia Obstructive Autoimmune Trauma
What are typical findings of chronic pancreatitis?
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)
How do you treat chronic pancreatitis?
Enzyme supplements
Reduce fat intake
What complications are associated with pancreatitis?
Ascites
Pancreatic pseudocyst
Diabetes, malabsorption, vit malabsorbtion
When is pancreatic cancer usually diagnosed? What is the rate of survival?
USUALLY DIAGNOSED LATE W/ SXS OFTEN NONSPECIFIC: weight loss, visceral abdominal pain, jaundice
5 YEARS SURVIVAL RATE OF <5%
