Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Unit 2 Clin Med III > L9: Pancreatitis > Flashcards

L9: Pancreatitis Flashcards

1
Q

Endocrine and endocrine pancreatic cells

A

Endocrine: islet of langerhans
Excorine: acinar cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Biggest causes of Acute pancreatitis

A

Gallstones
Chronic alcohol abuse
*****

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Men get acute pancreatitis from _____ and women get it from ____

A

Men: alcohol
Women: gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute pancreatitis presentation

A

Acute onset, after eating

Midepigastric → radiates to back

Constant, steady boring pain, severe

Aggravators: lying supine, food, alcohol
Relievers: sitting and leaning forward with knees flexed

N/V/A, abdominal distension/swelling
Diaphoresis, hematemesis, SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute pancreatitis exam

A

Tachycardia, Tachypnea, Fever, Hypotension
Guarding, decreased bowel sounds
+/- Jaundice, pallor, diaphoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clues to the origin of acute pancreatitis

A

Severe necrotizing pancreatitis→ Cullen’s sign, Grey-Turner’s sign, panniculitis (erythematous nodules)

Ileus→ Abdominal distention, hypoactive bowels

Choledocholithiasis or edema pancreatic head→ Scleral icterus

Alcoholic abuse→ Hepatomegaly

Hyperlipidemia→ Xanthomas

Mumps→ Parotid swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

General labs for acute pancreatitis

A

BC – Elevated WBC
CMP
Creatinine
Glucose→ hyperglycemia or hypoglycemia
Calcium - hypocalcemia
Elevated Bilirubin
LFTs→ ALT→ Alanine aminotransferase (ALT)
>150 U/L in the first 48hrs of symptom onset→ >85% PPV of gallstone pancreatitis
CRP→ 150 mg/dL at 48 hrs→ severe pancreatitis

Urine trypsinogen-2 dipstick test
Rapid, noninvasive, High sensitivity + specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pancreatic enzyme labs for acute pancreatitis

A

Amylase→ Rises in 6-12 hrs, peaks 48 hrs, normalizes in 3-5 days. (20% have normal level)

Lipase→ Rises in 4-8 hrs, peaks 24 hrs, normalizes in 8-14 days. More specific to pancreatic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who gets genetic testing for acute pancreatitis

A

Onset <35 or strong family history

Make sure they get genetic counseling before and after testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Criteria for diagnosis of acute pancreatitis

A

2 of the following:

  1. Clinical presentation
    Acute persistent, severe, epigastric pain
    Often radiating to the back
  2. Elevated serum lipase or amylase
    3X or greater than normal
  3. Consistent imaging findings
    CT with contrast, MRI or US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acute pancreatitis management

A

Inpatient , NPO until pain + N/V controlled +/- NG tube

IV opioid analgesia, antiemetics

Aggressive hydration: fluid resuscitation with crystalloids→ reduced morbidity + mortality, prevents necrosis

Infective necrosis→ Imipenem

Monitor: Vitals, I+Os, Labs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Aggressive hydration +/- Imipenem

A

The mainstay of tx for acute pancreatitis
Fluids prevent necrosis
Imipenem has good pancreas penetration in cases of infective necrosis (give if you see Cullen’s sign, gray-turner’s sign, or panniculitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of acute pancreatitis

A 
decreasing urinary output
rising creatinine
respiratory failure
increased pain
fever
leukocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Early ______ is not recommended for acute pancreatitis because ______

A

Early CT

most cases are uncomplicated, or complications don’t occur until 3 days after onset. IV contrast may worsen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Imaging indicated for suspected pancreatitis, and what might be seen

A

Abdominal ultrasound

Gallstones, posterior shadowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Abdominal xray for acute pancreatitis

A

Gallstones

sentinel loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CT of the abdomen will show ______ in acute pancreatitis

A

Enlargement of pancreas

Severity of disease/complications: inflammation, calcification, pseudocyst, necrosis, abscess, hemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Initial testing for recurrent pancreatitis, risk of malignancy, or unclear cause

A

EUS

Evaluate pancreatic duct abnormalities, tumors involving ampulla, pancreatic cancer, microlithiasis (gallbladder or common bile duct), early chronic pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Test for recurrent pancreatitis with neoplasm or stricture, or if EUS shows abnormal findings

A

ERCP

Visualize biliary + pancreatic ductal anatomy (dilation), “clubbing of side branches”, obtain cytology or biopsy. Therapeutic stone removal, stent insertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Imaging indicated if risk of malignancy, or if a stone in the common bile duct isn’t visible on CT or US

A

MRCP

Lower risk of nephrotoxicity, Increased characterization, view of biliary + pancreatic ducts, Fluid collections. Necrosis, Abscess, Pseudocyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

I GET SMASHED mnemonic for causes of acute pancratitis

A

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion/Snakes
Hyperlipidemia/Hypercalcemia
ERCP
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Medications associated with acute pancreatitis

A 
Acetaminophen
Amiodarone
Cannabis
Carbamazepine
Chlorothiazide/HCTZ
Codeine
Dexamethasone
Enalapril
Estrogens
Erythromycin
Furosemide
Losartan
Methimazole
Metronidazole
Pravastatin/Simvastatin
Procainamide
Tetracycline
Trimethoprim-sulfamethoxazole
Tuberculosis antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Complications of pancreatitis

A 
1. Local complications:
Peripancreatic fluid collection
Pancreatic pseudocyst→ see right
Necrosis
Gastric outlet dysfunction
Splenic and portal vein thrombosis
2. Systemic Inflammatory Response Syndrome (SIRS) → present on admission, persists >48 hours 
3. Organ failure:
Cardiovascular, Respiratory, Renal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Early CT isn’t indicated for acute pancreatitis, but you for sure have to get one for these patients:

A

> 72 hours of symptom onset + suspect complications:

Persistent or recurrent abdominal pain
Increased in pancreatic enzyme level after initial decrease
New or worsening organ dysfunction
Sepsis→ fever and increased WBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

A pancreatic pseudocyst is best seen on _____

A

CT abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pancreatic pseudocyst

A

Palpable mass in the mid-epigastric area in 10% of patients with acute pancreatitis

+/- Symptoms→ Abdominal pain, Early satiety, N/V

27
Q

Pancreatic pseudocyst prognosis and management

A

Can spontaneously resolve or continue to enlarge
Complicated by rupture, hemorrhage, or infection
Treatment→ Surgery vs. drainage→ Indicated if symptomatic or infected

28
Q

Acute inflammation of the pancreatic parenchyma and peripancreatic tissues without necrosis

A

Interstitial edematous acute pancreatitis

29
Q

Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis

A

Necrotizing acute pancreatitis

30
Q

Classification of severity of acute pancreatitis

A

Mild→ no organ failure, no local or systemic complications

Moderate→ transient organ failure <48 hours, no local or systemic complications

Severe→ organ failure>48 hours, 1+ local complication(s), 1+ systemic complication(s)

31
Q

A simple and accurate predictor of acute pancreatitis disease severity

A

SIRS

It’s present on admission and persists >48 hours

32
Q

Initial findings that indicate severe pancreatitis

A

Characteristics: >55 yrs old, obesity, altered mental status and comorbidities

Labs: BUN>20mg/dL or rising, hematocrit > 44% or rising, increased creatinine

Radiographic findings: many or large extrapancreatic fluid collections, pleural effusions, pulmonary infiltrates

33
Q

APACHE score (acute pancreatitis)

A

Acute Physiology and Chronic Health Examination)
Mild→ Decreasing values in first 48 hrs
Severe→ Increasing values in first 48 hrs

More complex and cumbersome
Does not differentiate between interstitial and necrotizing

34
Q

Ranson Criteria

A 
Initial signs
Age > 55
WBC > 16, 000
Glucose > 200 mg/ml
AST > 250 IU/L
LDH > 350 IU/L
Delayed signs (next 48 hrs)
HCT drop > 10%
BUN ↑ > 5 mg/dl
Calcium < 8 mg/dl
pO2 < 60 mmHg
Serum albumin < 3.2 mg/dl
Fluid sequestration 4-5 L

Mortality
Score < 3 = 0-3%
Score > 3 = 11-15%
Score > 6 = 40%

35
Q

Causes of death from acute pancreatitis

A

1st 2 weeks: SIRS/organ failure

After 2 weeks: Sepsis, other complications

36
Q

Preventing recurrence of acute pancreatitis

A

Treat the underlying cause:

Gallstone pancreatitis

  1. ERCP if CBD stone
  2. Elective cholecystectomy

Alcoholic pancreatitis→ Abstinence from alcohol

Hypertriglyceridemia
1. Dietary modification
2. Lipid lowering medications
Drug induced→ Discontinue offending medication

37
Q

Etiology of chronic pancreatitis

A 
alcohol induced disease (most)
cystic fibrosis
hereditary
idiopathic
smoking
 5-20% with acute pancreatitis develop chronic disease
38
Q

Chronic presentation presents similarly to repeated episodes of acute pancreatitis (early) or continuous inflammation, and can include be one of 2 main presentations:

A

Exocrine Insufficiency→ malabsorption: :

  1. Steatorrhea: ↑ excretion of fecal fat, Greasy, foul smelling stool
  2. Weight loss: Fear of eating, Malabsorption

Endocrine Insufficiency→ Diabetes:

  1. Polydipsia, polyuria, polyphagia
  2. Insulin dependent
  3. Brittle DM→ alpha and beta cells affected
39
Q

Diabetes+Steatorrhea+Calcification

A

Classic triad of chronic pancreatitis

40
Q

Labs for chronic pancreatitis

A

Amylase + lipase→ “normal” or slightly increased
Bilirubin + alkaline phosphatase→ +/-mildly elevated
↑ Glucose

Secretin stimulation test:
Cumbersome, expensive, not used often
Abnormal if 60% of exocrine function lost

Fecal Fat testing

41
Q

Test of choice for steatorrhea and gold standard for quantitative fecal fat

A

Fecal Fat testing

  1. 72 hour quantitative fecal fat preferred over qualitative testing of a spot sample (Gold Standard)
  2. Fecal Elastase (test of choice for steatorrhea)
42
Q

Complications of chronic pancreatitis

A 
Chronic pain
Pseudocyst
Abscess formation
Fistula formation
Pancreatic Ascites
Mesenteric venous thrombosis
43
Q

Which pancreatitis has a higher mortality?

A

Acute

44
Q

Imaging for chronic pancreatitis

A

Abdominal Xray→ scattered calcifications (30%)

Abdominal CT→ calcifications, ductal dilations, pseudocysts

MRCP→ pancreatic + biliary ducts imaging, gaining popularity

ERCP→ “chain-of-lakes” appearance is gold standard. More invasive→ used less often

45
Q

Management of chronic pancreatitis

A

Behavior modification→ ETOH abstinence, smoking cessation, small low fat meals

Early identification of complications
Treatment of complications
• Diabetes management
• Malabsorption management→ Pancreatic enzyme supplements

Pain relief→ +/- Amitriptyline or SSRI
Interventional Pain Specialist → referral
• Opioids - long acting better control
• Nerve Blocks
• Celiac plexus – Ethanol or steroids

Endoscopic procedures
• Dilation or Stenting

Resection

46
Q

Chain of Lakes

A

ERCP of chronic pancreatitis

Gold standard

47
Q

Who gets pancreatic cancer

A

M>F, >45 years

Etiology: Abnormal glucose metabolism, Insulin resistance, Obesity, Chronic pancreatitis

Risk: smoking, high body mass, sedentary, non-hereditary chronic pancreatitis, pancreatic cysts, +/- ETOH + age

48
Q

How do you diagnose pancreatic cancer

A

It’s NOT a clinical diagnosis def use labs and imaging

49
Q

Pancreatic cancer presentation

A

epigastric pain, jaundice, weight loss

asthenia (fatigue/weakness), N/A, back pain, dark urine, steatorrhea, hepatomegaly, RUQ/epigastric mass, ascites

Exam:
Abdominal pain + Palpable gallbladder→ courvoisier sign, nontender. Jaundice/ icterus

50
Q

When to look for cholestasis

A

Jaundice or epigastric pain

51
Q

Pancreatic cancer labs

A 
Assay of serum aminotransferases
Alkaline phosphatase
Bilirubin
Serum lipase – if epigastric pain (indicates acute pancreatitis)
*CA 19-9*
Tumor marker used in pancreatic cancer
 Sens/spec – 80-90%
 Elevations relative to tumor size
52
Q

Most common type of pancreatic cancer

A

Exocrine pancreatic cancer

(vs endocrine is 5%)

53
Q

All tumors related to the pancreatic ductal and acinar cells and their stem cells

A

Exocrine pancreatic cancer

54
Q

Ductal adenocarcinoma of the pancreas

A

Most common type of exocrine pancreatic cancer
Most involve head, few are resectable
Most present with locally advanced or metastatic disease
very poor prognosis

55
Q

Management of pancreatic cacner

A

Only potential cure is resection
Whipple procedure: pancreaticoduodenectomy

Biliary Obstruction
• Biliary stent
• Decompress bile duct

Gastric obstruction: (N/V, anorexia)
• Decompress stomach
• Surgical palliation

Pain
• Narcotics
• Chemotherapy vs. Radiation

56
Q

Imaging for choledocholithiais

A

MRCP or ERCP

57
Q

Abdominal ultrasound for pancreatic cancer

A

if jaundiced→ Detects biliary tract/CBD dilation, Level of obstruction, Mass

Epigastric pain + weight loss without jaundice→ lacks sensitivity for small tumors <3 cm, can’t clearly ID necrosis, so use CT

58
Q

Triple Phase Thin Sliced Enhanced Helical CT of Abdomen with 3D reconstruction

A

Preferred for suspected pancreatic cancer with epigastric pain and weight loss, but NO jaundice

59
Q

Do an abdominal CT if _______. It shows ______

A

if mass seen on ultrasound→ confirms mass, asses extent of disease

  1. Mass appears typical, resectability assessed, + pt is fit for major surgery→ no further testing
  2. In doubt→ additional testing
60
Q

ERCP is therapeutic in cases of pancreatic cancer if:

A

choledocholithiasis remains in differential
biliary decompression required
double duct sign

61
Q

Use MRCP for pancreatic cancer if

A

ERCP is contraindicated

62
Q

Best for tissue diagnosis of pancreatic cancer

A

EUS

No biopsy is needed if it’s a resectable disease with typical imaging, they’ll do it when they excise the tumor

63
Q

Test of choice for staging and resection eligibility of pancreatic cancer. FNA.

A

Contrast Enhanced Helical CT

Unit 2 Clin Med III (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions