appy/pancreas Flashcards
appendicitis
age
gender
% of population
age between 10-30 years old
male 2 fold
affects 10% of population
2 most common causes of appendicitis
hypertrophied lymphoid tissue(55-65%)
fecalith(35%)
organisms that can cause appendicitis
and 2 other less common causes
CMV, adenovirus, histoplasma
collagen vascular disease and inflammatory bowel disease
mcburneys point
12 hrs after appencitis pain starts then localizes at RLQ then pain becomes constant and worse with movement
fever in appendicitis?
low grade
psoas sign
pt supine and attempts to raise leg against resistance. do for appendicitis
obturator sign
pt supine and attempts to flex and internally rotate right hip with knee bent. do in appendicitis
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
most common abdominal emergency in the US
appendicitis
presentation of 20% [of painful] appendicitis
perforation and peritonitis
causing high grade fever, generalized pain, and increased leukocytosis
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
what if a pt has retrocecel appendicitis
then pain will occur with on a rectal exam
treatment of appendicitis
and perforation
appy
if perforation, do broad spectrum antibiotics before and after surgery
hamburger sign
if a pt wants to eat, consider a dx other than appendicitis
rovsing sign
deep palpation of LLQ leading to RLQ pain
acute appendicitis
hyperlipidemia(esp hyper-triglyceridemia)
cholelithiasis, alcohol abuse, autoimmune disease
trauma, drugs, hypercalcemia, penetrating PUD
causes of pancreatitis
antiretroviral drugs for HIV can be assoc with what
acute pancreatitis
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
amylase vs lipase for acute pancreatitis
serum lipase more sensitive and specific, only with elevations 3fold or higher
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
