GI: pancreas

Question 1

MC inpatient GI diagnosis?

Answer 1

acute pancreatitis

Question 2

GET SMASHED pneumonic for?

Answer 2

causes of pancreatitis

Gallstones
Ethanol
Trauma

Steroids 
Mumps (kids) 
Autoimmune 
Scorpion sting 
Hyperglycemia 
Hyperlipidemia 
ERCP 
Drugs

Question 3

ransons criteria is used for?

-list it

Answer 3

clinical prediction rule for predicting severity of acute pancreatits. 3 or more means more severe cause

At admission: 
age >55 
Leukocyte: >16,000 
GLucose: >200 
LDH: >350 
AST: >250 

At 48 hours: 
Calcium: <8.0 % 
Hematocrit falls >10% 
Oxygen PO2: <60mm Hg 
BUN >5mg/dL with IV fluids 
Base Deficit > 4 mEq/L 
Sequestration of fluid >6L

Question 4

which is more specific and sensitive to actue pancreatits: amylase or lipase

Answer 4

Lipase*****

Question 5

best imaging choice for:

1. acute pancreatitis
2. chronic pancreatitis

Answer 5

1. abdominal CT

2. abdominal CT or MRCP (Magnetic resonance cholangiopancreatography)

Question 6

which is irreversible and reversibile: acute and chronic pancreatitis

Answer 6

chronic–irreversible

acute–reversible

Question 7

Pancreatitis:

• etiolgies—2 MCC
• CM
• Pe
• diagnosis–best inital test? labs, imagign, etc

Answer 7

MCC: gallstones (40%) and ETOH (35%)

• meds: thiazides, protease inhibitors (HIV), valproic acid (anti seizure), exenatide (DM)
• iatrogenic: ERCP, viral infections (MUMPs in kids), CF, scorpion sting

CM:

• epigastric pain: constant, boring, +rad to the back
• pain exacerbates if supine or eating
• pain relieved with leaning forward, sitting or fetal position
• nausea
• vomiting

PE: 
\+low grade fever 
\+tachypnea 
\+hypotention 
\+leukocytosis 
\+epigastric tenderness 
\+abdominal distention 
IF HEMORRHAGIC: 
\+cullens sign--periumbical ecchymosis 
\+Grey turner sign--flank echymosis

• diagnosis Requires 2 of 3:
  1. acute onset of severe, persistent, epigastric pain–often rad to back
  2. elevation in serum lipase or amylase 3x normal
  3. charactersitic finding on imaging: NOT required if PT meets the first two

LABS:

• incr amylase and lipase= best initial test
• hypocalcemia
• leukocytosis

Imaging:

• TOC: Abdominal CT
• transabdomainl US
• xray-SENTINEL LOOP–localized ileus of a small segment of bowel in the LUQ that ends abruptly (“cuts off”) at the region of pancreatic inflammation; pancreatic calcifications suggest chronic pancreatitis
• ERCP– if severe

TX:

• 90% recover in 3-7 days w/o complications + need supportive care only
• ->NPO
• –>IV LR
• –>analgesics

**Advancing diet once pain resolved, clinically improved–>patient directed leads to improved outcomes

Question 8

MCC of pancreatitis in kids?

Answer 8

MUMPS