appy/pancreas Flashcards by Mai Wells

appendicitis

age

gender

% of population

age between 10-30 years old

male 2 fold

affects 10% of population

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2 most common causes of appendicitis

hypertrophied lymphoid tissue(55-65%)

fecalith(35%)

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organisms that can cause appendicitis

and 2 other less common causes

CMV, adenovirus, histoplasma

collagen vascular disease and inflammatory bowel disease

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mcburneys point

12 hrs after appencitis pain starts then localizes at RLQ then pain becomes constant and worse with movement

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fever in appendicitis?

low grade

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psoas sign

pt supine and attempts to raise leg against resistance. do for appendicitis

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obturator sign

pt supine and attempts to flex and internally rotate right hip with knee bent. do in appendicitis

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dx of appendicitis (lab results and imaging)

leukocytosis(10,000 to 20,000), maybe hematuria and pyuria

and abdominal CT is preferred to locate the appendix

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most common abdominal emergency in the US

appendicitis

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presentation of 20% [of painful] appendicitis

perforation and peritonitis

causing high grade fever, generalized pain, and increased leukocytosis

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initial symptom of appendicitis

then what

other presentating symptoms

periumbilical or epigastric pain

then in 12 hours, pain localizes to RLQ(mcburney pt) and becomes constant

worsened by movement, leading to rebound tenderness on exam

N/V and low fever are common

diarrhea and high fever are uncommon

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what if a pt has retrocecel appendicitis

then pain will occur with on a rectal exam

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treatment of appendicitis

and perforation

appy

if perforation, do broad spectrum antibiotics before and after surgery

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hamburger sign

if a pt wants to eat, consider a dx other than appendicitis

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rovsing sign

deep palpation of LLQ leading to RLQ pain

acute appendicitis

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hyperlipidemia(esp hyper-triglyceridemia)

cholelithiasis, alcohol abuse, autoimmune disease

trauma, drugs, hypercalcemia, penetrating PUD

causes of pancreatitis

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antiretroviral drugs for HIV can be assoc with what

acute pancreatitis

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sx of epigastric pain radiating to the back. pain lessens when pt leans forward or lies in fetal position

N/V and sweats

acute pancreatitis

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amylase vs lipase for acute pancreatitis

serum lipase more sensitive and specific, only with elevations 3fold or higher

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tx of acute pancreatitis

stop oral intake (to prevent continued secretion of pancreatic juices),

fluid volume must be restored and maintained. parenteral hyperailmentation should be started early to prevent nutritional depletion

ERCP with spincterotomy if gallstones are the cause

pain management with opiods

consider antibiotics

what is ransons criteria for

leukocyte count

blood glucose level

LDH and AST

arterial Po2

base deficit

calcium and BUN

poor prognosis of acute pancreatitis

leukocyte count >16,000

blood glucose level >200

LDH >350 and AST >250

arterial Po2 <60

base deficit > 4

calcium falling and BUN rising

classic triad of chronic pancreatitis

pancreatic calcification, steatorrhea, DM. occurs in 20% of pts

labs of chr pancreatitis

amylase may be elevated early but will decrease with each episode of pancreatitis and cease to be a useful marker.

abdominal pain film xray-to see calicifications in 20-30% of pts; gallstones may be seen

U/S: “chain of lakes”

5th leading cause of death

pancreatic cancer

courvoisier sign

jaundice and palpable gallbladder with cancer of pancreatic head

dx pancreatic neoplasm

CT to delineate disease and search for metastases and angiography to look for vascular invasion

tx for pancreatic neoplasm radiation/chemo? prognosis

modified whipple procedure in those without metastases susequent radiation and chemotherapy are controversial poor prognosis

range of presentation of pancreatitis

can range from mild episodes of deep epigastric pain with N/V to the sudden onset of severe pain with shock

classic presentation of pancreatitis

epigastric pain that radiates to the back the pain lesses when the pt leans forward or lies in a fetal position N/V common fever, leukocytosis, sterile peritonitis present

what 3 things indicate a grave prognosis for pancreatitis

severe hypovolemia, ARDS, tachycardia greater than 130 bpm

grey turner sign Cullen sign

hemorrhagic pancreatitis: bleeding into these areas grey turner sign (flank) Cullen sign (umbilical)

serum amylase and serum lipase with acute pancreatitis

elevation of serum amylase occurs but may be transiet and can return to nml after 48-72 hours serum lipase is more sensitive and specific then amylase for acute pancreatitis, but only with elevations of 3fold or higher

acute pancreatitis WBC liver enzymes bilirubin sugars electrolytes

WBC generally elevated and hemoconcentration may occur w/ 3rd spacing liver enzymes may increase as a result of biliary obstruction mild hyperbilirubinemia and bilirubinuria hyperglycemia and hypocalcemia may occur

imaging for pancreatitis

\*\* CT best choice for diagnosis ultrasound helpful to look for gallstones plain films may reveal a "sentinal loop" or "colon Cutoff sign"

monitor pancreatitis pts for what complications

pancreatic pseudocyst renal failure pleural effusion hypocalcemia pancreatic abscess

cholelithiasis, PUD, hyperparathyroidism, hyperlipidemia main cause

causes of chronic pancreatitis main cause 90% of cases is alcohol abuse

presentation of chronic pancreatitis

same as acute pancreatitis with the addition of fat malabsorption and steatorrhea late in the disease fecal fat may be elevated if malabsorption is present

tx of chronic pancreatitis diet pain definitive tx

same as acute pancreatitis low fat diet recommended at discharge surgical removal of pancreas for pain control \*\* address the underlying cause: commonly alcohol

increased age, obesity, tobacco, chronic pancreatitis, previous abdominal radiation, family hx

risk factors for pancreatic neoplasm

exam of a pancreatitic neoplasm

abdominal pain common(epigastric that radiates to the back), depending on location of tumor, it can radiate jaundice and palpable gallbladder may be seen in pts with cancer of the pancreatic head

pancreatic cancer kind mean survival diet risk factors age weight

95% adenocarcinoma mean survival in most cases less than a year low in fruits/veggies but high in red meats and sugars over 60 obese

% of pancreatic pts surgical candidates major pancreatic surgery and survival rate other surgery

20% whipple procedure results in a 5 year survival rate of 20% distal pancreatectomy depending on tumor location

nontender, palpable gallbladder with jaundice

pancreatic cancer

plain films may reveal a "sentinal loop" or "colon cutoff sign" "chain of lakes"

acute chronic

common cause of acute pancreatitis in kids

trauma

4 complications of acute pancreatitis

pancreatic pseudocyst fistula formation hypocalcemia renal failure

\*\* CT best choice for diagnosis ultrasound helpful to look for gallstones plain films may reveal a "sentinal loop" or "colon Cutoff sign"

imaging for pancreatitis

U/S: "chain of lakes"

chr pancreatitis