High-Yield Concepts in Pancreatic Disorders (Gastrointestinal Diseases) Flashcards
Most common cause of Acute Pancreatitis
Gallstones, followed by alcohol
Currently accepted pathogenic theory for Pancreatitis
Autodigestion
Major symptom of Acute Pancreatitis
Abdominal pain (more intense when supine, relieved by sitting up)
Cullen’s Sign
Blue discoloration around the umbilicus from hemoperitoneum
Turner’s Sign
Blue-red-purple or green brown discoloration of the flanks from tissue catabolism of hemoglobin
Laterality of pleural effusion in Pancreatitis
Most frequent on the left
Recommended screening tests
Serum lipase and amylase levels
Single best enzyme to measure for the diagnosis
Lipase (more specific)
Pancreatitis from Hypertriglyceridemia
Serum triglyceride levels usually >11.3 mmol/L (>1000 mg/dL)
Risk factors for severe disease and mortality in Acute Pancreatitis
Hematocrit > 44%
Azotemia with BUN >22 mg/dL
Best imaging study for initial evaluation of suspected pancreatic disorder and for complications of Pancreatitis
Abdominal CT Scan
Imaging study if gallstone disease is suspected in Acute Pancreatitis
Ultrasonography
Diagnostic tests of choice to evaluate the pancreatic duct
EUS and MRCP (but ERCP still needed for treatment of biliary and pancreatic duct lesions)
Best way to prevent ERCP-induced Pancreatitis
Avoidance of ERCP for diagnostic purposes in high-risk patients
Hallmark of treatment in Acute Pancreatitis
Bowel rest, intravenous hydration with crystalloid, analgesia
Preferred method of nutritional support in Acute Pancreatitis
Enyteral-feeding with a nasojejunal tube (vs. TPN)
Diagnosis of Pancreatic Infection
CT-guided needle aspiration with Gram stain and culture
Most common organisms in Pancreatic Infection
Gram-negative bacteria of intestinal origin
Most common location of Pancreatic Pseudocyst
Pancreatic body or tail (only 15% in the head)
Usual presenting complaint of Pseudocyst
Abdominal pain
Usual cause of death from Pancreatic Pseudocyst
Rupture and hemorrhage of the pseudocyst
Most frequently involved artery in Pseudoaneurysms
Splenic artery, followed by inferior and superior pancreatic duodenal arteries
Most common cause of Chronic Pancreatitis in US adults
Alcoholism
Most common cause of Chronic Pancreatitis in US children
Cystic fibrosis
Predominant symptoms of Chronic Pancreatitis
Abdominal pain or maldigestion and weight loss
Diagnostic test with best sensitivity/specificity for Chronic Pancreatitis
Secretin stimulation test (abnormal once >60% of pancreatic exocrine function has been lost)
Most reproducible measurement in the Secretin Test
Maximal HCO3 concentration
Most common cause of pancreatic calcification
Alcohol
Cornerstone of pancreatic therapy
Pancreatic enzymes
Most common congenital anatomic variant of the pancreas
Pancreas divisum
