DSA 1: Approach to Pancreatic Patient

Question 1

In the process of acute pancreatitis, the conversion of trypsinogen to trypsin in the pancreas results in?

What does saponification lead to?

Answer 1

1) Autodigestion of pancreas

2) Hypocalcemia

Question 2

Why is acute pancreatitis considered an emergency?

Answer 2

High mortality associated

Question 3

What are the two most common causes of acute pancreatitis?

Answer 3

1) Gallstones

2) Heavy alcohol use

Question 4

How does acute pancreatitis present on H&P?

Answer 4

Epigastric pain that radiates straight through to the back

Question 5

What is the diagnostic criteria for acute pancreatitis?

Answer 5

At least 2/3 of:

1) Epigastric pain
2) Lipase (and amylase) elevated
3) CT points to pancreatitis

Question 6

What is the radiography used to diagnose acute pancreatitis?

When is it best to be done?

When should it be avoided?

Answer 6

1) Rapid-bolus IV contrast-enhanced CT
2) After 3 days of severe acute pancreatitis
3) When serum creatinine is greater than 1.5 mg/dL

Question 7

What points to severe acute pancreatitis when using the BISAP score?

Answer 7

1) BUN > 25 mg/dl
2) Impaired mental status
3) SIRS
4) Age > 60
5) Pleural effusion

Question 8

What APACHE II score indicates higher mortality due to acute pancreatitis?

Answer 8

Greater than 8

Question 9

What is the first thing you need to do when treating acute pancreatitis?

Answer 9

IV fluid resuscitation

Question 10

What are potential complications of acute pancreatitis?

Answer 10

1) 3rd spacing
2) Prerenal azotemia
3) Pleural effusion
4) Infection
5) Pseudocysts
6) ARDS

Question 11

Ecchymosis of umbilicus from retroperitoneum fluid and bleeding indicates?

Ecchymosis of flank from fluid and blood in the retroperitoneum indicates?

Answer 11

1) Cullen’s sign

2) Grey Turner sign

Question 12

What often signals the presence of an adjacent irritative or inflammatory process in a patient that has acute pancreatitis?

Answer 12

Sentinel loop or localized ileus

Question 13

Infected pancreatic necrosis with secondary gas formation leads to?

What is the treatment?

Answer 13

1) Emphysematous pancreatitis

2) Surgical debridement and antibiotics

Question 14

What is a clinical sign of hypocalcemia which consist of twitching of muscles innervated by facial nerve?

What is elicited in hypocalcemia when the ionized calcium level is 1.75–2.25 mmol/L causing the hand to adopt a characteristic posture when the sphygmomanometer cuff is inflated above the systolic blood pressure within 3 minutes?

Answer 14

1) Chvostek sign

2) Trousseau sign

Question 15

Which is a better indicator for acute pancreatitis, amylase or lipase?

Answer 15

Lipase

Question 16

What is the most frequent cause of chronic pancreatitis?

Answer 16

Alcoholism

Question 17

What exocrine insufficiency can manifest with chronic pancreatitis?

What endocrine insufficiency?

Answer 17

1) Steatorrhea caused by malabsorption

2) DM

Question 18

How does chronic pancreatitis present on H&P?

Answer 18

1) Epigastric pain
2) Steatorrhea
3) Unintentional weight loss
4) Fatigue

Question 19

How is chronic pancreatitis diagnosed from labs?

Answer 19

1) Decreased Fecal elastase ( < 100 mcg/gram)

2) Glucose/HbA1C

Question 20

What is elevated in chronic pancreatitis from autoimmune etiology?

Answer 20

IgG4

Question 21

How is chronic pancreatitis diagnosed on plain XR and CT?

What is there concern for if tumefactive chronic pancreatitis is seen on CT?

Answer 21

1) Calcifications

2) Pancreatic cancer

Question 22

What mnemonic helps with the causes for chronic pancreatitis?

Answer 22

TIGAR-O

1) Toxic-Metabolic
2) Idiopathic
3) Genetic
4) Autoimmune
5) Recurrent
6) Obstructive

Question 23

What toxic metabolic causes chronic pancreatitis?

What is the idiopathic cause?

What is the genetic cause?

What is the autoimmune cause?

What is the recurrent cause?

Answer 23

1) Alcohol
2) Smoking
3) Cystic fibrosis
4) Hypergammaglobulinemia (IgG4)
5) Recurrent acute pancreatitis

Question 24

What association of chronic pancreatitis is important to treat?

Answer 24

DM

Question 25

What is the main cause of death from chronic pancreatitis?

Answer 25

Pancreatic carcinoma

Question 26

When is pancreatic insufficiency mostly seen?

Answer 26

1) Chronic pancreatitis
2) Cystic fibrosis
3) Pancreatic cancer

Question 27

Steatorrhea is due to malabsorption of?

Answer 27

Triglycerides

Question 28

What exocrine insufficiency point to pancreatic insufficiency?

What endocrine?

Answer 28

1) Decreased fecal chymotrypsin and fecal elastase

2) DM

Question 29

What clinical features should make you put pancreatic cancer at the top of your differential?

Answer 29

1) Painless jaundice

2) New onset DM

Question 30

What sign is caused by pancreatic carcinoma that is associated with repeated attacks of multiple venous thrombosis at different and changing sites?

What sign of pancreatic carcinoma is characterized by a palpable gallbladder?

Answer 30

1) Trousseau sign of Malignancy

2) Courvoisier sign

Question 31

What is the marker for pancreatic cancer?

Answer 31

CA 19-9

Question 32

Jaundice commonly complicates tumors of the pancreatic head due to?

Answer 32

Biliary obstruction

Question 33

What gene is associated with gastrinoma (ZE syndrome) and insulinoma of the pancreas?

Answer 33

MEN 1