Chapter 79: Pancreatitis and Cholecystitis Flashcards
True or False Most cases (~80%) involve only mild inflammation of the pan- creas, a disease state with a mortality rate of <1%, which generally resolves with only supportive care
True Most cases (~80%) involve only mild inflammation of the pan- creas, a disease state with a mortality rate of <1%, which generally resolves with only supportive care
True or False
About 5% of all patients who undergo endoscopic retrograde cholangio- pancreatography for treatment of gallstones develop pancreatitis within 30 days
True
About 5% of all patients who undergo endoscopic retrograde cholangio- pancreatography for treatment of gallstones develop pancreatitis within 30 days
Medications associated with acute pancreatitis can be categorized into three groups
- Antiretrovirals
- Chemotherapy
- Immunosuppressants
Can cause potentially fatal pancreatitis
2’,3’-Dideoxyinosine
Antiretrovirals that has lower risk of pancreatitis
- Lamivudine
- Nelfinavir
Most common cause of acute pancreatitis
Gallstone
True or False
Pain described as lower abdominal pain or dull or colicky pain is highly unlikely to be pancreatitis
True
Pain described as lower abdominal pain or dull or colicky pain is highly unlikely to be pancreatitis
Bluish discoloration around the umbilicus signifying hemoperitoneum
Cullen’s sign
Reddish-brown discoloration along the flanks signifying retroperitoneal blood or extravasation of pancreatic exudate
Grey-Turner sign
True or False
The gold standard laboratory diagnosis for acute pancreatitis is lipase
False
There is no gold standard laboratory diagnosis for acute pancreatitis
True or False
Amylase rises within a few hours after the onset of symptoms, peaks within 48 hours, and normalizes in 3 to 5 days
True
Amylase rises within a few hours after the onset of symptoms, peaks within 48 hours, and normalizes in 3 to 5 days
This laboratory test predicts gallstone pancreatitis
Alanine aminotransferase (ALT) >150U/L
Characteristic findings in IV contrast abdominal CT
(1) pancreatic parenchymal inflammation with or without peripancreatic fat inflammation
(2) pancreatic parenchymal necrosis or peripancreatic necrosis
(3) peripancreatic fluid collection
(4) pancreatic pseudocyst
How fluids prevents complications in pancreatitis?
The benefit of fluid resuscitation may result from increased micro- and macrocirculatory support of the pancreas, which prevents complications such as pancreatic necrosis
Which fluid will you give in acute pancreatitis?
PLR. Because PNSS may cause a nongap hyperchloremic acidosis and can worsen pancreatitis
Complication of acute pancreatitis that is characterized by transient organ failure (<48 hours), local complications, or systemic complications
Moderately severe acute pancreatitis
When is the best time to do CT scan in acute pancreatitis?
At least 72hours after the onset of symptoms
True or False
Systemic inflammatory response syndrome at admission and persistent at 48 hours predicts severe acute pancreatitis more simply and as accurately as the various scoring systems
True
Systemic inflammatory response syndrome at admission and persistent at 48 hours predicts severe acute pancreatitis more simply and as accurately as the various scoring systems
Progression of acute to chronic pancreatitis is common in what population?
Alcoholic
Most common symptoms of gallstone?
Asymptomatic
The most common complication of gallstone disease
Biliary colic
Primary choledocholithiasis
Gallstones within the common bile duct arising from within the bile duct
Secondary choledocholithiasis
Gallstone within the common bile duct that formed in the gallbladder and then migrating to the common bile duct
Microlithiasis composed of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts
Biliary sludge
True or False
Acute acalculous cholecystitis is more common than acute calculous cholecystitis and it is less likely to result in complications
False
Acute acalculous cholecystitis is less common than acute calculous cholecystitis and it is more likely to result in complications
Classification of gallstone?
- Pigment stone (brown and black)
- Cholesterol stone
Most common pathogen seen in acute cholecystitis
Polymicrobial infection
Most common classification of stone in gallstone?
Cholesterol stone which is radioluscent
Classification of stone in gallstone that more common in asian
Brown stone
Biliary colic demonstrates significant circadian periodicity, with a peak in symptom occurrence around ____
Biliary colic demonstrates significant circadian periodicity, with a peak in symptom occurrence around midnight
Diagnostic criteria for acute cholecystitis
Local signs:
Murphy’s sign
Right upper quadrant mass, pain, or tenderness
Systemic signs:
Fever
Elevated C-reactive protein
Elevated WBC count
Suspected: One local sign and one systemic sign
Definite: One local sign, one systemic sign, and imaging findings of acute cholecystitis
The most sensitive and specific serum marker of choledocholithiasis
Abnormal γ-glutamyl transpeptidase is the most sensitive and specific serum marker of choledocholithiasis
The imaging modality of choice for acute cholecystitis
Abdominal US
Normal diameter of common bile duct
<5mm
First line of therapy in acute cholecystitis inn treating pain
NSAIDS IV
The classic radiographic appearance of gallstone ileum?
Rigler’s triad: a small bowel obstruction, pneumobilia, and an ectopic gallstone
Complications of acalculous cholecystitis
Gangrene and perforation
A common cause of postcholecystectomy pain
Choledocholithiasis
