Clinical- Pancreas Disorders Flashcards
While doing an EUS, what does large diffuse enlargement of the pancreas, peripheral rim of hypoattenuation, and irregular narrowing of the main pancreatic duct indicate
Autoimmune
While using EUS, what does hyperechoic foci with shadowing of the pancreas indicate
Calculi in the main pancreatic duct
Autoimmune pancreatitis is assocaited with which antibody
Hypergammaglobbulinemia (IgG4)
What are common complications of chronic pancreatitis
Chronic abdominal pain Brittle diabetes mellitus Opioid/Narcotic addiction Steatorrhea and malnutrition Pancreatic cancer
What finding on a CT in a patient with chronic pancreatitis becomes alarming
Tumefactive chronic pancreatitis is a sign for pancreatic cancer
What are the risk factors that will increase the risk for more serious pancreatitis with the high levels of fluid sequestration in the 3rd spacing
Younger age Alcohol Higher hematocrit Higher serum glucose Systemic inflammatory response syndrome
Pancreatic cancers (especially neuroendocrine) are associated with which familiar cancer
MEN1
What is the colon cut off sign
Air in the transverse colon that abruptly ends around the location of the pancreatitis inflammation (causes a Splenic flexure spasm)
When should a contrast CT be avoided
When a patient does not have proper kidney function, as the creatinine will be >1.5
Which laboratory findings are consistent with an increased mortality due to SAP
Hypoalbuminemia and elevated serum lactic dehydrogenase (LDH)
What are the characteristics of a insulinoma
Associated with MEN1
Hypersecretion of insulin
High insulin and creative protein during hypoglycemia
What can be given if there is tetany due to the hypocacemia
Calcium gluconate
What are the cancers of the pancreas that are commonly associated with MEN1
- Gastrinoma (ZE)
- Insulinoma
What are the clinical signs associated with pancreatic adenocarcinoma
- Painless jaundice
- pain, midepigastric that radiates to the pack, especially at night
- Trousseau sign of malignancy
- Courvoisier Sign (palpable gall bladder)
What is the process of saponification during acute pancreatitis
- “Making into soap”
- Interaction of fatty acids (due to lipase) and calcium form a more solid structure, but also result in low calcium
What are the most common causes of acute pancreatitis
Cholelithiasis and alcohol
When can a secretin test be done for chronic pancreatitis
Sensitive test, where it becomes abnormal when >60% of pancreatic function is lost
What is the result of acute pancreatitis on calcium levels
Decreased due to saponification
What is the cardinal symptom in patients with chronic pancreatitis
Pain
Steatorrhea
Malabsorption
What is the outcome during acute pancreatitis and the increases in BUN
The larger the increases in BUN, the higher the mortality
What is the cause of steatorrhea in patients with CF or chronic pancreatitis
EPI or exocrine pancreas insufficiency
What should be examined if they triglyceride levels are >1000
Check the lipid panel for Severe Acute pancreatitis
What is the main cause of death in patients with chronic pancreatitis
Pancreatic cancer
What is associated with a bad outcomes with regards to SIRS and elevated BUN
Presence of elevated BUN at admission with a rise in BUN 24 hours after, in addition to SIRS
What are some non-pancreatic cases of increased amylase levels
- High intestinal obstruction
- Gastroenteritis
- Mumps (salivary amylase)
- Ectopic pregnancy
- Opioids
- Abdominal surgery
What are the characteristics of gastrinoma in MEN1
Zollinger ellison syndome
- nonbeta islet cell tumors, with the hypersecretion of gastrin
- commonly found in the duodenum, then the pancreas
What is chronic pancreatitis characterized by
Irreversible damage to the pancreas leading to:
- Chronic pain and recurrent pancreatitis
- pancreatic exocrine and endocrine insufficiency
What is the most frequent cause of chronic pancreatitis
Alcoholism
Which scans are useful in the case of an acute pancreatitis event
Plain X ray
Unenhanced CT
What is given to patients with acute pancreatitis who are having the cases of persistent shock
Vasopressors
What are the specific tests done for chronic pancreatitis
There is not one as lipase and amylase are normal
What is the preferred method testing for acute pancreatitis
Increased lipase (more accurate than amylase)
What is the most important treatment of acute pancreatitis
Safe, aggressive IV fluid resuscitation
What imaging can be done for chronic pancreatitis
Plain films to look for pancreatic calcification
What is the cause of seminal loop sign
Air in the small intestine in the left upper quadrant
What are the fecal tests that can be done for patients suspected of pancreatic insufficiency
Fecal elastase 1 and a small bowel biopsy
What are the criteria to be labeled as acute pancreatitis or severe acute pancreatitis
2 of the 3:
- Abdominal pain in the epigastric area that radiates to back
- threefold election in the serum lipase or amylase
- Conformational findings of AP on cross section align abdominal imaging
What is the relation between ARDS and acute pancreatitis
In severe cases, acute pancreatitis can lead to cases of acute respiratory distress, usually 3-7 days later
-those who required large crystalloid volumes and colloid volumes t maintain BP
What is the description of pain during acute pancreatitis
Boring pain in the epigastric and periumbilical region that may radiate to the back
Why should careful consideration be taken in performing an ERCP during a pancreatitis
A complication of ERCP is pancreatitis
