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4. GASTROINTESTINAL > GI Section VI: Pancreatitis > Flashcards

GI Section VI: Pancreatitis Flashcards

1
Q

What are the most common Etiology of Pancreatitis?

A

Gallstones and Alcohol combined make up to 80% of the cases

Iatrogenic = ERCP
Medications = Valproic Acid
Trauma = NAT
Pancreatic CA
Infection = Viral in children
Hypercalcemia
Hyperlipidemia
Autoimmune Pancreatitis
Pancreatic divisum
Groove (para-duodenal) pancreatitis,
Tropic
Parasite induced

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2
Q

Prognosis can be estimated with?

A

Balthazar Score

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3
Q

Think about pancreatitis as

A

Mild (no necrosis)
Severe (+ necrosis)

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4
Q

Patients with necrosis don’t start doing terrible until =

A

They get infected - mortality rate is 50-70%

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5
Q

Outcomes are directly correlated with?

A

Degree of necrosis

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6
Q

Severe acute pancreatitis has a biphasic course.

A

Pro inflammatory phase (Week 1-2)

Anti-inflammatory periode (Week 3-4)

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7
Q

This is a sterile response in which infection rarely occurs

A

Pro inflammatory phase (Week 1-2)

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8
Q

the risk o f translocated intestinal flora and the subsequent development of infection increases in this period

A

Anti-inflammatory period (Week 3-4)

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9
Q

< 4weeks + NO necrosis =

A

Acute Peripancreatic Fluid Collection

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10
Q

> 4 weeks + NO Necrosis =

A

Pseudocyst

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11
Q

< 4weeks + NECROSIS =

A

Acute necrotic Collection

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12
Q

> 4 weeks + NECROSIS =

A

Walled-off necrosis

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13
Q

Vascular Complications of pancreatitis

A
  • Splenic Vein and Portal Vein Thrombosis (Isolated gastric varices can be seen secondary to splenic vein occlusion)
  • Pseudo-aneurysm of the GDA (Gastroduodenal artery) and Splenic Artery
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14
Q

Non-Vascular Complications of pancreatitis

A
  • Abscess, infection
  • Gas - sign of infected fluid collection
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15
Q
A

Inflamed pancreas = hypoechoic (edematous) relative to the liver (opposite of normal)

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16
Q

What are the two ducts of the pancreas?

A

MAJOR = Wirsung

MINOR = Sontorini

17
Q

Normal draiaing of the pancreatic ducts:

A

MAJOR DUCT = INFERIOR PAPILLA

MINOR = SUPERIOR PAPILLA

Santorini = SMALL and SUPERIOR

18
Q

the most common anatomic variant of the human pancreas

A

Pancreatic Divisum

19
Q

Pancreatic Divisum occurs when?

A

the main portion of the pancreas is drained by the minor or accessory papilla

20
Q

Main clinical relevence if you see panreatic divisum?

A

Increased risk of pancreatitis

21
Q

Chronic Pancreatitis

A

end result of prolonged inflammatory change = IRREVERSIBLE fibrosis

22
Q

Acute pancreatitis and chronic pancreatitis are thought of as

A

Different disease process

Most cases, acute pancreatitis do not result in chronic disease

23
Q

most common causes of Chronic pancreatitis

A

Cholithiasis and alcohol (90%)

Alcohol is #1

24
Q

Imaging findingso of Chronic pancreatitis can be thought as?

A

Early

or

Late

25
Q

Balthazar Score

A
26
Q

Early Chronic Pancreatitis

A
  • Loss of T1 signal (pancreas is normally the brightest T1 structure in the body)
  • Delayed Enhancement
  • Dilated Side Branches ~
27
Q

Late Chronic Pancreatitis

A
  • Commonly small, uniformly atrophic - but can have focal enlargement
  • Pseudocyst formation (30%)
  • Dilation and beading of the pancreatic duct with calcifications
28
Q

what is the most characteristic finding of Chronic Pancreatitis?

A

Dilated and Beaded appearance of the pancreatic duct, with Intraductal Calcifications.

29
Q
A

Chronic Pancreatitis

“Chain of LAkes”

Dilated and Beaded appearance of the pancreatic duct, with Intraductal Calcifications.

30
Q

Chronic Pancreatitis Duct Dilation vs Pancreatic Malignancy Duct Dilation

Chronic Pancreatitis =

Cancer =

A

Chronic Pancreatitis =
Dilation is Irregular
Duct is < 50% of the AP gland diameter

Cancer =
Dilation is uniform (usually)
Duct is > 50% of the AP gland diameter (obstructive atrophy)

31
Q

Complications of Chronic Pancreatitis

A

Pancreatic cancer (20 years o f CP = 6% risk o f Cancer)

4. GASTROINTESTINAL (47 decks)

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