EXAM #2: PANCREATITIS

Question 1

What is the Sphincter of Oddi?

Answer 1

• Circular band of muscle at the bottom of the biliary tree

- Controls the flow of pancreatic juices and bile into 2nd part of duodenum

Question 2

What neutralizes gastric acid as the meal enters the small intestine?

Answer 2

Bicarbonate

Question 3

What turns a meal into liquid for absorption?

Answer 3

Digestive enzymes

Question 4

What signals the body to store ingested nutrients?

Answer 4

Insulin

Question 5

Why are patients with acute pancreatitis kept NPO for 48 hours after presentation?

Answer 5

Pancreatic rest
- Turn off the pancreas

When the patient eats again, some pain is normal and indicates that the pancreas is turned back on.

Question 6

What pancreatic endocrine cells secrete glucogon?

Answer 6

Alpha

Question 7

What pancreatic endocrine cells secrete insulin?

Answer 7

Beta

Question 8

What pancreatic endocrine cells secrete somatostatin?

Answer 8

Delta

Question 9

What pancreatic exocrine cells produce bicarbonate?

Answer 9

Centroacinar

Question 10

What pancreatic exocrine cells produce digestive enzymes?

Answer 10

Basophilic cells

Question 11

What are the two primary etiologies of acute pancreatitis?

Answer 11

1) Alcohol
2) Gallstones

Choledocholithiasis= a gallstone that is stuck in the bile duct.

Question 12

What is the classical manifestation of acute pancreatitis?

Answer 12

• Constant epigastric abdominal pain that radiates to the back
• Anorexia

Question 13

What are the classic physical exam findings in acute pancreatitis?

Answer 13

• Appears in pain
• Tachycardia
• Epigastric tenderness with guarding

Note that you may see “Cullen’s or Grey Turner’s” signs i.e. periumbilical bleeding and flank bleeding

Question 14

When should you image a patient with suspected acute pancreatitis?

Answer 14

1) New case (no prior history)

2) Atypical presentation

Question 15

What imaging modalities should be used for imaging if there is suspected acute pancreatitis?

Answer 15

1) US

2) CT w/ IV contrast

Question 16

What test do you need to order before giving IV contrast?

Answer 16

BMP and Creatinine

Question 17

What labs should be ordered to work-up acute pancreatitis?

Answer 17

1) CBC*
2) BMP or CMP*
3) Lipase
4) Liver enzymes and bilirubin

*Few cases (in sim lab) where this isn’t warranted

Question 18

What are the synthetic liver function markers?

Answer 18

Albumin and PT/INR

Question 19

How is acute pancreatitis treated?

Answer 19

1) NPO
2) Hydration–several boluses of IV fluid
3) Pain control
4) +/- antibiotics

Question 20

What do you need to do after treating acute pancreatitis?

Answer 20

Address the underlying cause

Question 21

How long does it take for the clinical resolution of acute pancreatitis?

Answer 21

3-7 days

Question 22

What are the potential serious complications of acute pancreatitis?

Answer 22

1) Shock
2) ARDS
3) Renal failure
4) GI hemorrhage
5) DIC

Question 23

What are the less severe complications of acute pancreatitis?

Answer 23

1) Metabolic abnormalities
- Hypocalcemia (Soponification)
- Hyperglycemia
- Hypertriglyceridemia
2) Pseudocyst formation
3) Pancreatic necrosis
4) Infection

Question 24

What are the complications of chronic pancreatitis?

Answer 24

1) DM
2) Persistent abdominal pain
3) Chronic diarrhea
4) Malnourishment

Question 25

What does a 2:1 ratio or greater of AST:ALT indicate?

Answer 25

Alcoholic liver disease