Case- Pancreatitis Flashcards by Cat Johnson

What signs to look for in suspected pancreatitis?

Epigastric tenderness to palpation
Voluntary guarding
Can be hypotensive 
Cullen Sign
Grey-Turner sign

How well did you know this?

Not at all

Perfectly

Which test is more sensitive for pancreatitis in pts w/ETOH pancreatitis & Hypertriglyceridemia: Amylase or Lipase?

Lipase

How well did you know this?

Not at all

Perfectly

Which test remains elevated longer? (8-14d) Amylase or Lipase?

Lipase

How well did you know this?

Not at all

Perfectly

Which test is more specific for acute Pancreatitis? Amylase or lipase?

Lipase

How well did you know this?

Not at all

Perfectly

Elevations of Lipase in Acute Pancreatitis?

3x > ULN

How well did you know this?

Not at all

Perfectly

What are the normal levels of Amylase & Lipase?

Amylase:35-118
Lipase: 0-160

How well did you know this?

Not at all

Perfectly

Two imaging modalities for Dx Acute Pancreatitis

Abdominal CT w/Contrast

Abdominal U/S

How well did you know this?

Not at all

Perfectly

Dx of acute pancreatitis requires 2/3 of what?

Acute onset of persistent, severe, epigastric pain often radiating to the back
Elevation in serum lipase OR amylase 3x or greater than the ULN
Characteristic findings of acute pancreatitis on imaging

How well did you know this?

Not at all

Perfectly

Dx of acute pancreatitis requires 2/3 of what?

Acute onset of persistent, severe, epigastric pain often radiating to the back
- Elevation in serum lipase OR amylase 3x or greater than the ULN
Characteristic findings of acute pancreatitis on imaging

How well did you know this?

Not at all

Perfectly

4 Common etiologies for pancreatitis?

Most common?

-Gallstones (MC 40-70%)
-ETOH
(uncommon if not a heavy drinker for >5yrs)
-Hyperlipidemia
(serum TG >1000)
-Post-ERCP

How well did you know this?

Not at all

Perfectly

Mild Pancreatitis

No organ failure, no local/systemic complications

How well did you know this?

Not at all

Perfectly

What are the local complications of Acute Pancreatitis

Acute peripancreatic fluid collection
Pancreatic pseudocyst
Necrosis

How well did you know this?

Not at all

Perfectly

What are the sytstemic complications of Acute Pancreatitis

Examples of systemic complications are exacerbations of underlying comorbidities

How well did you know this?

Not at all

Perfectly

Moderate Pancreatitis

No organ failure
or
transient organ failure is <48 hours
and/or local complications

How well did you know this?

Not at all

Perfectly

Severe Pancreatitis

Persistent organ failure
(>48 hours)
involving 1+ organs

How well did you know this?

Not at all

Perfectly

Edematous Pancreatitis vs Necrotizing Pancreatitis

Most cases of acute pancreatitis are:
acute interstitial edematous pancreatitis

20% will become necrotizing pancreatitis.

Necrotizing pancreatitis has worse outcomes,
can also become secondarily infected (with bacteria or fungus)

Scoring systems for severity/risk of pancreatitis. Accuracy?

Ranson’s criteria, APACHE II score, SIRS score, BISAP score, harmless acute pancreatitis score, CT severity index

None have great accuracy.

Initial management of Acute Pancreatitis

LR or NS?

Aggressive fluids for the first 24-48 hours!

LR!

Benefits of aggressive LR & fluid replacement in acute pancreatitis?

LR:
reduces incidence of SIRS,
reduction in hospital stay
ICU admissions

Fluid replacement is associated with reduction in M&M.
Fluid resuscitation also helps with pain control (hypovolemia can worsen ischemia & pain)

Clues to knowing you have adequately resuscitated the patient? (5)

normalization of HR
Normalization of BP,
Increase urine output,
reduction in H&H
Reduction in BUN

Pain control?

Opioids (IV)

Hydromorpine or Fentanyl

ABX?

not recommened

Nutrition?

NPO during work up

Management for Gallstones

ERCP early on (<24 hours) if they have gallstone pancreatitis + cholangitis.

Cholecystectomy after recovery in all pts with gallstone pancreatitis

Management of Hypertriglyceridemia

severe restriction of dietary fat. Consider plasmapheresis.

Rx admin to decrease TG if plasmaparesis unavailable

IV insulin administration

Long term Tx for management of Hypertriglyceridemia

lipid management w/ Rx therapy + dietary modification + weight loss

T/F: Patients with acute pancreatitis are at risk for developing prediabetes and diabetes after their first episode of acute pancreatitis.

True

T/F: WBC often elevated in Acute Pancreatitis

True

Nutrition if: | moderate to severe pancreatitis and oral feeding not tolerated

enteral feeding (nasogastric tube) if they can’t tolerate oral feeding by day 5.

Nutrition if: | patient doesn’t have an ileus, nausea, or vomiting

resume oral intake within 24 hours if tolerated. Start with: - low residue - low fat - soft diet - advance cautiously as tolerated.

Acute Pancreatitis management if etiology is gallstones?

cholecystectomy | ERCP

T/F: If Pancreatitis is from ETOH it can be recurrent?

True

Heavy drinking is how many drinks for men/women per week?

7 Women | 14 Men

T/F: Acute Pancreatitis presents better with laying down & worse when sitting up?

False. | Opposite.

Revised Atlanta criteria for mild, moderate and severe pancreatitis?

I GET SMASHED | Acronym for Acute Pancreatitis

I- idiopathic G- GALLSTONES (40-70%) E- ETOH T- Trauma ``` S-steroids M-mumps A- autoimmune S-Scorpion sting H-Hypertriglyceremia E- ERCP D- Drugs- SULFA ``` *also pregnancy, pancreatic cancer, genetic mutations,

What can a CT with show for pancreatitis by gallstones

Diffuse pancreatic enlargement with edema and Perihepatic fat stranding

What can inadequate hydration lead to in acute pancreatitis?

-hypotension -ATN -reduction in other organ perfusion (possibly leading to necrosis) -Ischemia -Pain