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GIR Test 4 > B5.065 Pancreatitis > Flashcards

B5.065 Pancreatitis Flashcards

1
Q

definition of acute pancreatitis

A

an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems

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2
Q

clinical presentation of acute pancreatitis

A
  1. symptoms, such as epigastric pain, consistent with disease
  2. serum amylase or lipase > 3x normal limit
  3. radiologic imaging consistent with the diagnosis, usually using CT or MRI
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3
Q

epidemiology of acute pancreatitis

A

17 per 100,000
2-3% mortality
median age depends on etiology

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4
Q

common etiologies of acute pancreatitis

A 
alcohol
biliary tract
drugs
ERCP
trauma
AIDs
vasculitis
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5
Q

most common signs and symptoms associated w acute pancreatitis

A

severe epigastric pain, often radiating throughout back
nausea and emesis
fatigue and malaise
fever and chills

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6
Q

less common, ominous signs associated with acute pancreatitis

A

Grey-Turner’s sign: hemorrhagic discoloration of the flanks

Cullen’s sign: hemorrhagic discoloration of the umbilicus

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7
Q

pathophys of duct obstruction pancreatitis

A

duct obstruction > interstitial edema > impaired blood flow > ischemia > acinar cell injury

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8
Q

pathophys of acinar cell injury pancreatitis

A

alcohol/drugs/trauma/ischemia > release of intracellular proenzymes and lysosomal hydrolases > activation of enzymes > acinar cell injury

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9
Q

pathophys of defective intracellular transport pancreatitis

A

metabolic injury > delivery of proenzymes to lysosomal compartment > intracellular activation of enzymes > acinar cell injury

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10
Q

actions of activated enzymes

A

interstitial inflammation and edema
proteolysis
fat necrosis
hemorrhage

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11
Q

possible clinical outcomes of acute pancreatitis

A

90-95% mild, no organ failure
5-10% severe necrotizing, organ failure > 60% sterile and 40% infected
of infected necrosis, 15-25% mortality

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12
Q

lab tests done for acute pancreatitis

A
  1. serum amylase
  2. serum lipase
  3. serum trypsinogen
  4. urine amylase
  5. serum glucose
  6. serum bilirubin and lk phos
  7. serum calcium
  8. CBC
  9. BUN, Cr
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13
Q

expected value of serum amylase

A

2-3x normal in 2-12 hours

returns to normal in 3-4 days

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14
Q

expected value of serum lipase

A

rises and remains elevated for 7-14 days

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15
Q

expected value of serum trypsinogen

A

elevated with acute

decreased with chronic

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16
Q

expected value of serum calcium

A

hypocalcemia with acute

can contribute to globules of saponified fat in abdomen

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17
Q

radiologic and diagnostic studies for acute pancreatitis

A 
CT
MRI/MRCP
US
ERCP
fine needle aspiration (FNA)
18
Q

what types of diagnostic features can be identified on CT?

A

normal vs. edematous vs necrotizing pancreatitis

19
Q

appearance of edematous pancreatitis on CT

A

enlarged and homogenously enhancing pancreatic gland

less well demarcated than normal pancreas on CT

20
Q

appearance of necrotizing pancreatitis on CT

A

poorly defined

heterogeneous areas of unperfused tissue

21
Q

what is Ranson’s criteria?

A

classification of acute pancreatitis disease severity
made up of lab values at admission and at 48 hrs out
predictor of mortality

22
Q

2012 Atlanta classification of acute pancreatitis

A

2 phases: early (1st week), late (> 1 week)
3 severities: mild (no organ failure), moderate (organ failure < 48 hr), severe (organ failure > 48 hr)
2 types: edematous, necrotizing

23
Q

classification of interstitial edematous pancreatitis fluid collections

A

< 4 weeks after onset : acute peripancreatic fluid collection (APFC)
>4 weeks after onset: pseudocyst

24
Q

how is a pseudocyst different from APFC

A

thickened wall

more distinguishable formation

25
Q

classification of necrotizing pancreatitis fluid collections

A

< 4 weeks after onset: acute necrotic collection (ANC)
>4 weeks after onset: walled off necrosis (WON)
any collection can be sterile or infected

26
Q

patterns of necrosis

A

parenchymal alone
peripancreatic alone
combines (most common)

27
Q

treatment of acute interstitial edematous pancreatitis

A

early enteral nutrition
fluid resuscitation
correction of metabolic/electrolyte abnormalities
pain control

28
Q

additional treatment of biliary pancreatitis

A

laparoscopic cholecystectomy indicated once pain has resolved (during same hospitalization)

29
Q

why is fluid resuscitation necessary in acute pancreatitis

A

can cause fluid shift in abdomen leading to intravascular volume depletion

30
Q

additional treatment of pseudocyst

A

drainage to resolve fluid accumulation

31
Q

management of an asymptomatic pseudocyst

A

usually < 6 cm is asymptomatic
follow up in 6-8 weeks
stable: < 4cm follow up, > 4 cm elective therapy

32
Q

management of symptomatic pseudocyst

A

depending on location and size > FNAB/drainage

if recurs > operation

33
Q

why are pancreatic enzymes sometimes not elevated despite damage?

A

too damaged for raised enzymes, not producing them

“hamburger meat”

34
Q

appearance of infection on CT

A

black spots on pancreas due to gas (produced by bacteria)

35
Q

how does the pancreas acquire infection

A

translocation of gut flora into pancreas when there is damage

36
Q

generalized treatment protocol for necrotizing pancreatitis

A

admission to ICU for hemodynamic monitoring
aggressive volume resuscitation
correction of metabolic/electrolyte abnormalities
broad spectrum antibiotics
early enteral nutrition
organ system support
CT guided FNA for gram stain/culture

37
Q

treatment of infected necrosis

A

clinically stable: continue antibiotics and observe delayed minimally invasive surgical, endoscopic or radiologic debridement
clinically unstable: prompt surgical debridement

38
Q

predominant bacteria infecting the pancreas

A 
E.coli
pseudomonas
enterobacter
proteus
bacteroides
39
Q

favored antibiotics for treatment of acute pancreatitis

A

tissue penetrating

Imipenem, Meropenem

40
Q

why is early enteral nutrition favored for all types of pancreatitis

A

maintain gut health

prevents migration of bacteria

GIR Test 4 (20 decks)

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