B5-065 Pancreatitis Flashcards
treatment for acute pancreatitis caused by gallstones
- fluid
- anti-emetics
- pain control
- GI consult- lap chole
keep patient NPO if they have acute pancreatitis caused by
hypertriglyceridemia
treatment for acute pancreatitis caused by hypertriglyceridemia
insulin
if acute pancreatitis due to autoimmune disorder is suspected, what lab should be ordered?
IG4
treatment of acute pancreatitis due to autoimmune cause
steroids
acute pancreatis can be caused by […] procedure
ERCP
mid-epigastric pain radiating to back
acute pancreatitis
discoloration of tissue on the flanks due to tissue catabolism of hemoglobin
turner’s sign
perforation or retroperitoneal bleed
blue discoloration in the periumbilical region due to hemoperitoneum
cullen’s sign
best imaging modality for acute pancreatitis
CT abdomen with contrast
US if you have hepatobiliary concerns
diagnostic criteria for acute pancreatitis
- acute epigastric pain radiating to back
- 3x increase in serum lipase or amylase
- imaging findings consistent with disease
requires 2 of 3
if the dx of acute pancreatitis is established by abdominal pain and serum pancreatic enzymes..
CT with contrast not normally required
characterized by absence of organ failure/systemic complications
mild acute pancreatitis
characterized by transient organ failure/systemic complications (resolves in 48 hrs)
moderately severe acute pancreatitis
AKI
characterized by persistent organ failure that many involve one or more organs persisting greater than 48 hrs
severe acute pancreatitis
BISAP score
- BUN > 25
- Impaired Mental Status
- SIRS
- Age > 60
- Pleural effusion
0-2 points = low mortality, 3-5= high mortality
local complications of acute pancreatitis
3
- interstitial edamatous pancreatitis
- necrotizing pancreatitis
- vascular complications and hemorrhage
systemic complications can refer not only to organ failure, but also
exacerbation of pre-existing comorbid conditions
CAD, HF, COPD
on CECT, pancreatic parenchyma shows a relatively homogenous enhancement. no findings of pancreatic necrosis
interstitial edematous pancreatitis
5-15% of acute peripacreatic fluid collections persist beyond 4 weeks. at that point they become a
psuedocyst
- well defined non-epithelized wall
- contain no solid material
pancreatic pseudocysts
- well circumscribed
- homogenous fluid density
- no non-liquid component
- well defined wall, completely encapsulated
pancreatic pseudocyst
- heterogenous
- no defineable wall
- lack of pancreatic parenchymal enhancement with contrast
acute necrotic collection
most common vascular complication of acute pancreatitis
venous thrombosis of splenic vein
mainstay of pancreatitis treatment
4
- fluids
- pain management
- anti-emetics
- nutrition
are antibiotics indicated in the treatment of acute pancreatitis?
no
unless evidence of extrahepatic infection
ascending cholangitis, bacteremia, UTI, pneumonia
when is enteral feeding indicated?
moderate to severe pancreatitis
start with NJ tube, gastro- or jejuno- tube may be necessary for severe
nutrition should be addressed within […] hours
24-72
unless due to hypertriglyceridemia
majority of infection is acute pancreatitis is caused by
4
E coli
pseudomonas
klebsiella
enterococcus
antibiotics known to penetrate into pancreatic necrosis
- carbapenems
- fluroquinolones
- ceftazidime
- cefepime + metronidazole
- elevated amylase and lipase
- cross sectional imaging findings of pancreatic edema and mesenteric stranding
simple interstitial pancreatitis
when should cholecystectomy be performed following pancreatitis?
after the abdominal exam has normalized
- improves outcomes
- fewer readmissions for recurrent pancreatitis
- decreases overall cost
early cholecystectomy
after abdominal exam normalizes
best initial treatment for acute pancreatitis
- fluid resuscitation
- correction of metabolites/electrolytes
- early enteral nutrition
there is no proven benefit to the use of […] in acute pancreatitis
antibiotics
encapsulated homogenous fluid collection older than 4 weeks
pancreatic pseudocyst
heterogenous fluid collection would suggest
necrotizing pancreatitis
acute necrotic collection, walled off necrosis, etc
best treatment for pancreatic pseudocyst
open/endoscopic cyst-gastrectomy
percutaneous drainage is indicated for
fluid collections separate from pancreas
necrosectomy is indicated for
necrotic pancreas
psuedocysts less than […] can be observed as they will resolve
6 cm
diagnostic imaging modality of choice in acute pancreatitis
contrast enhanced CT
best treatment for severe pancreatitis with infected fluid
- EUS
- IV antibiotics
- possible cystogastromy/necrosectomy
