Chapter 371 - Acute and Chronic Pancreatitis (2090-2102)

Question 1

What is the major symptom of acute pancreatitis?

Answer 1

Abdominal pain

Question 2

What is the pathologic type of acute pancreatitis wherein the pancreas blood supply is interrupted in which the extent of necrosis may correlate with the severity of the attack and its systemic complications?

Answer 2

Necrotizing Pancreatitis

Question 3

What is the pathologic type of acute pancreatitis wherein the pancreas blood supply is maintained and is generally self-limited?

Answer 3

Interstitial Pancreatitis

Question 4

Which phase of acute pancreatitis involves the activation, chemoattraction, and sequestration of leukocytes and macrophages in the pancreas, resulting in an enhanced intrapancreatic inflammatory reaction?

Answer 4

Second Phase

Question 5

Which phase of acute pancreatitis is characterized by intrapancreatic digestive enzyme activation and acinar cell injury?

Answer 5

Initial Phase

Question 6

True or False:

Acinar cell injury is the consequence of trypsin de-activation.

Answer 6

False.

Acinar cell injury is the consequence of trypsin activation.

Question 7

This may occur as the result of hemoperitoneum and is manifested by a faint blue discoloration around the umbilicus.

Answer 7

Cullen’s sign

Question 8

This is a blue-red-purple or green-brown discoloration of the flanks which reflects tissue catablolism of hemoglobin from severe necrotizing pancreatitis with hemorrhage.

Answer 8

Turner’s sign

Question 9

True or False:

There is no correlation between the severity of pancreatitis and the degree of serum lipase and amylase elevations.

Answer 9

True.

Question 10

Defined as a score of 2 or more for one of these three organ systems using the modified Marshall scoring system.

Answer 10

Organ failure

Question 11

What are the risk factors for severity in severe acute pancreatitis?

Answer 11

• Age >60 years
• Obesity, BMI >30
• Comorbid disease (Charlson Comorbidity Index)

Question 12

Which classification of acute pancreatitis according to severity is without local complications or organ failure?

Answer 12

Mild Acute Pancreatitis

Question 13

Which classification of acute pancreatitis according to severity is characterized by transient organ failure (resolves in <48 h) or local or systemic complications in the absence of persistent organ failure?

Answer 13

Moderately Severe Acute Pancreatitis

Question 14

Which classification of acute pancreatitis according to severity is characterized by persistent organ failure (>48 h)?

Answer 14

Severe Acute Pancreatitis

Question 15

This is characterized by diffuse gland enlargement, homogenous contrast enhancement, and mild inflammatory changes or peripancreatic stranding by local morphologic features on CT imaging.

Answer 15

Interstitial Pancreatitis

Question 16

This is characterized by lack of pancreatic enhancement by intravenous contrast agent and/or presence of findings of peripancreatic necrosis by local morphologic features on CT imaging.

Answer 16

Necrotizing Pancreatitis

Question 17

What is the most important treatment intervention for acute pancreatitis?

Answer 17

Safe, aggressive intravenous fluid resuscitation

Question 18

True or False:
A decrease in hematocrit and BUN during the first 6-12 h is strong evidence that sufficient fluids are being administered.

Answer 18

False.
A decrease in hematocrit and BUN during the first 12-24 h is strong evidence that sufficient fluids are being administered.

Question 19

What are the five clinical and laboratory parameters obtained within the first 24 h of hospitalization incorporated in the Bedside Index of Severity in Acute Pancreatitis (BISAP)?

Answer 19

• BUN >25 mg/dL
• Impaired mental status (Glasgow coma score <15)
• SIRS
• age >60 years
• pleural effusion on radiography

Question 20

True or False:

There is currently no role for prophylactic antibiotics in necrotizing pancreatitis.

Answer 20

True.

Question 21

What has been the cornerstone of therapy in the treatment of steatorrhea?

Answer 21

Pancreatic enzyme replacement