Clinical Approach to the Pancreatic Patient Flashcards
what are 6 causes of pancreatitis?
gallstones, heavy alcohol use, hypertriglyceridemia, trauma, medications, ERCP
what are signs of hypocalcemia?
Chvostek and Trousseau signs and tetany
why is there hypocalcemia with pancreatitis?
the process of saponification
what is the diagnostic criteria for acute pancreatitis?
at least 2 of the 3: epigastric pain, lipase (and amylase) 3x the ULN, CT changes
Why do you do a CT without contrast initially in a patient with acute pancreatitis?
these patients are so volume depleted that they are likely to have some form of AKI, so their creatinine level will be elevated
when should CT with contrast be avoided in pancreatitis patients?
when their creatinine is more than 1.5
if you were to get an abdominal x-ray in a patient with pancreatitis, what are two findings you might see?
- Sentinel loop: segment of air-filled small intestine (most commonly in LUQ) 2. Colon cutoff sign: gas filled segment of transverse colon abruptly ending at the area of pancreatic inflammation
what are the main complications associated with acute pancreatitis?
intravascular volume depletion, pleural effusions, pseudocysts, ARDS
how do you treat acute pancreatitis?
fluid resuscitation
what are 2 examples assessing prognosis of acute pancreatitis?
RANSON and BISAP
what does BISAP stand for?
BUN, impaired mental status, SIRS, Age >60, pleural effusion
what is the hypothesis of pathogenesis of chronic pancreatitis?
SAPE: sentinel acute pancreatitis event
what is the mnemonic for the causes of chronic pancreatitis?
TIGAR-O: toxic- metabolic (alcohol); idiopathic, genetic, autoimmune, recurrent, obstructive
what is the ultimate sign of history of chronic pancreatitis?
malabsorption (exocrine insufficiency- steatorrhea) and DM
what labs are important in the diagnosis of chronic pancreatitis?
fecal fat (elevated), fecal chymotrypsin (decreased), fecal elastase (decreased)
