DSA 1: Approach to Pancreatic Patient Flashcards
In the process of acute pancreatitis, the conversion of trypsinogen to trypsin in the pancreas results in?
What does saponification lead to?
1) Autodigestion of pancreas
2) Hypocalcemia
Why is acute pancreatitis considered an emergency?
High mortality associated
What are the two most common causes of acute pancreatitis?
1) Gallstones
2) Heavy alcohol use
How does acute pancreatitis present on H&P?
Epigastric pain that radiates straight through to the back
What is the diagnostic criteria for acute pancreatitis?
At least 2/3 of:
1) Epigastric pain
2) Lipase (and amylase) elevated
3) CT points to pancreatitis
What is the radiography used to diagnose acute pancreatitis?
When is it best to be done?
When should it be avoided?
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
What points to severe acute pancreatitis when using the BISAP score?
1) BUN > 25 mg/dl
2) Impaired mental status
3) SIRS
4) Age > 60
5) Pleural effusion
What APACHE II score indicates higher mortality due to acute pancreatitis?
Greater than 8
What is the first thing you need to do when treating acute pancreatitis?
IV fluid resuscitation
What are potential complications of acute pancreatitis?
1) 3rd spacing
2) Prerenal azotemia
3) Pleural effusion
4) Infection
5) Pseudocysts
6) ARDS
Ecchymosis of umbilicus from retroperitoneum fluid and bleeding indicates?
Ecchymosis of flank from fluid
and blood in the retroperitoneum indicates?
1) Cullen’s sign
2) Grey Turner sign
What often signals the presence of an adjacent irritative or inflammatory process in a patient that has acute pancreatitis?
Sentinel loop or localized ileus
Infected pancreatic necrosis with secondary gas formation leads to?
What is the treatment?
1) Emphysematous pancreatitis
2) Surgical debridement and antibiotics
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?
1) Chvostek sign
2) Trousseau sign
Which is a better indicator for acute pancreatitis, amylase or lipase?
Lipase
What is the most frequent cause of chronic pancreatitis?
Alcoholism
What exocrine insufficiency can manifest with chronic pancreatitis?
What endocrine insufficiency?
1) Steatorrhea caused by malabsorption
2) DM
How does chronic pancreatitis present on H&P?
1) Epigastric pain
2) Steatorrhea
3) Unintentional weight loss
4) Fatigue
How is chronic pancreatitis diagnosed from labs?
1) Decreased Fecal elastase ( < 100 mcg/gram)
2) Glucose/HbA1C
What is elevated in chronic pancreatitis from autoimmune etiology?
IgG4
How is chronic pancreatitis diagnosed on plain XR and CT?
What is there concern for if tumefactive chronic pancreatitis is seen on CT?
1) Calcifications
2) Pancreatic cancer
What mnemonic helps with the causes for chronic pancreatitis?
TIGAR-O
1) Toxic-Metabolic
2) Idiopathic
3) Genetic
4) Autoimmune
5) Recurrent
6) Obstructive
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?
1) Alcohol
2) Smoking
3) Cystic fibrosis
4) Hypergammaglobulinemia (IgG4)
5) Recurrent acute pancreatitis
What association of chronic pancreatitis is important to treat?
DM
What is the main cause of death from chronic pancreatitis?
Pancreatic carcinoma
When is pancreatic insufficiency mostly seen?
1) Chronic pancreatitis
2) Cystic fibrosis
3) Pancreatic cancer
Steatorrhea is due to malabsorption of?
Triglycerides
What exocrine insufficiency point to pancreatic insufficiency?
What endocrine?
1) Decreased fecal chymotrypsin and fecal elastase
2) DM
What clinical features should make you put pancreatic cancer at the top of your differential?
1) Painless jaundice
2) New onset DM
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?
1) Trousseau sign of Malignancy
2) Courvoisier sign
What is the marker for pancreatic cancer?
CA 19-9
Jaundice commonly complicates tumors of the head due to?
Biliary obstruction
What is associated with gastrinoma (ZE syndrome) and insulinoma of the pancreases?
MEN 1
