EXAM #2: PANCREATITIS Flashcards
What is the Sphincter of Oddi?
- Circular band of muscle at the bottom of the biliary tree
- Controls the flow of pancreatic juices and bile into 2nd part of duodenum
What neutralizes gastric acid as the meal enters the small intestine?
Bicarbonate
What turns a meal into liquid for absorption?
Digestive enzymes
What signals the body to store ingested nutrients?
Insulin
Why are patients with acute pancreatitis kept NPO for 48 hours after presentation?
Pancreatic rest
- Turn off the pancreas
When the patient eats again, some pain is normal and indicates that the pancreas is turned back on.
What pancreatic endocrine cells secrete glucogon?
Alpha
What pancreatic endocrine cells secrete insulin?
Beta
What pancreatic endocrine cells secrete somatostatin?
Delta
What pancreatic exocrine cells produce bicarbonate?
Centroacinar
What pancreatic exocrine cells produce digestive enzymes?
Basophilic cells
What are the two primary etiologies of acute pancreatitis?
1) Alcohol
2) Gallstones
Choledocholithiasis= a gallstone that is stuck in the bile duct.
What is the classical manifestation of acute pancreatitis?
- Constant epigastric abdominal pain that radiates to the back
- Anorexia
What are the classic physical exam findings in acute pancreatitis?
- 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
When should you image a patient with suspected acute pancreatitis?
1) New case (no prior history)
2) Atypical presentation
What imaging modalities should be used for imaging if there is suspected acute pancreatitis?
1) US
2) CT w/ IV contrast
What test do you need to order before giving IV contrast?
BMP and Creatinine
What labs should be ordered to work-up acute pancreatitis?
1) CBC*
2) BMP or CMP*
3) Lipase
4) Liver enzymes and bilirubin
*Few cases (in sim lab) where this isn’t warranted
What are the synthetic liver function markers?
Albumin and PT/INR
How is acute pancreatitis treated?
1) NPO
2) Hydration–several boluses of IV fluid
3) Pain control
4) +/- antibiotics
What do you need to do after treating acute pancreatitis?
Address the underlying cause
How long does it take for the clinical resolution of acute pancreatitis?
3-7 days
What are the potential serious complications of acute pancreatitis?
1) Shock
2) ARDS
3) Renal failure
4) GI hemorrhage
5) DIC
What are the less severe complications of acute pancreatitis?
1) Metabolic abnormalities
- Hypocalcemia (Soponification)
- Hyperglycemia
- Hypertriglyceridemia
2) Pseudocyst formation
3) Pancreatic necrosis
4) Infection
What are the complications of chronic pancreatitis?
1) DM
2) Persistent abdominal pain
3) Chronic diarrhea
4) Malnourishment
What does a 2:1 ratio or greater of AST:ALT indicate?
Alcoholic liver disease
