Chapter 79: Pancreatitis and Cholecystitis

Question 1

Medications associated with acute pancreatitis

Answer 1

antiretrovirals, chemotherapy, and immunosuppressants

Question 2

Characteristic of pain in acute pancreatitis

Answer 2

• located in the epigastrium
• Pain may radiate to the back, chest, or flank
• Pain may worsen with oral intake or lying supine and may improve with sitting up with the knees flexed
• acute, severe, and persistent abdominal pain, usually associated with nausea, vomiting, anorexia, and decreased oral intake

Question 3

associated with late, severe necrotizing pancreatitis

Answer 3

• Cullen’s sign
• Grey-Turner sign

Question 4

Formal diagnosis is based on at least two of three criteria:

Answer 4

1. clinical presentation consistent with acute pancreatitis
2. a serum lipase or amylase value significantly elevated above the upper limit of normal or,
3. imaging findings characteristic of acute pancreatitis (IV contrast-enhanced CT, MRI, or transabdominal US)

Question 5

true ot false

There is no gold standard laboratory diagnosis for acute pancreatitis

Answer 5

TRUE

Two current guidelines recommend:
1) amylase or lipase value be at least three times the upper limit of normal
2) lipase o f** two times** normal or an amylase of three times normal in a patient with the appropriate clinical presentation

Question 6

Level of alanine aminotransferase that predicts gallstone pancreatitis

Answer 6

> 150 U/L

alanine aminotransferase of >150 U/L within the first 48 hours of
symptoms predicts gallstone pancreatitis

Question 7

treatment for pancreatitis

Answer 7

• early aggressive hydration decreases morbidity and mortality
• IV opioid
• Initially on NPO
• Antiemetics

FLUIDS: Patients generally need a total of 2.5 to 4 L of fluid over the first 12 to 24 hours
- Crystalloids are the resuscitation fluids of choice
- Normal saline in large volumes may cause a nongap hyperchloremic acidosis and can worsen pancreatitis, possibly by activating trypsinogen and making acinar cells more susceptible to injury

Question 7

remarks on transition to feeding

Answer 7

if nausea and vomiting have resolved and pain has decreased, transition the patient to oral pain medications and small amounts of food. A low-fat solid foods diet provides more calories than a clear liquid diet and is safe

Question 8

Organ systems susceptible to organ failure

Answer 8

cardiovascular, respiratory, and renal

pay special attention during the patient’s initial evaluation

Question 8

Remarks on starting antibiotics

Answer 8

Acute pancreatitis by itself is not a source of infection, and prophylactic use of antibiotics and antifungals is not recommended