Lecture 23 - Medical Aspects of Pancreas and Billiary Tract Flashcards
The two most common causes of Acute pancreatitis are _____ disease, usually from stones, and _____ use.
Billiary disease, usually from stones
Alcohol use
The three categories for Pancreatitis are Mild, Moderate, and Severe, with the prognosis progressively worsening with each category.
Mild is categorized as no _____ failure and no Local or _____ complication. It usually resolves within ___ week.
Moderate is defined by local or _____ complications such as necrosis or transient organ failure < ____ hrs.
Severe is defined by _____ and persistent organ failure lasting > ____ hrs. The mortality rate at this point is about ____ %.
Organ failure
Systemic
1 week
Systemic
< 48hrs
SIRS (Systemic Immune Response Syndrome –> tachy, leukocytosis, fever, all that good stuff)
> 48hrs
50%
Diagnostic criteria for Acute pancreatitis requires at least 2 of the following:
- Acute onset ____ pain, often radiating to the back.
- Serum ____ and/or _____ levels elevated to 3-5x the upper limit of normal.
- Abnormal findings on imaging suggestive of pancreatitis.
- Acute onset abdominal pain
- Serum Lipase or Amylase
- Abnormal findings on imaging
The first line treatment for patients presenting with acute pancreatitis is _______ resuscitation (usually Lactated Ringer’s) within the first 12-24hrs.
Routine use of ______ is not warranted.
Oral ____ should begin as soon as possible. If not tolerated, begin Enteral within 72 hours.
ERCP is indicated in patients suspected for _____ obstruction or Cholangitis. If gall stones are determined to be the issue, the patient should undergo ______ before discharge.
Fluid
Antibiotics
Feeding
Billiary obstruction or Cholangitis
Cholecystectomy
Complications of Acute pancreatitis typically include ____ failure in the 1st week or Pancreatic Fluid Collections (PFC) beyond the 1st week.
PFC does not require treatment unless is progresses to Pseudocyst (typically from PFC that persists beyond 4 weeks) and/or Walled Off Pancreatic Necrosis (WOPN). How do these two types of PFC differ?
Both are well-defined walled off PFC, but Pseudocyst is typically clear and without debris. It is generally treated if the patient experiences symptoms. WOPN is turgid and has debris. WOPN may become infected, at which point Abs are indicated (Remember they are NOT indicated otherwise). Delay debridement of this type of wound for at least 4 weeks.
Chronic Pancreatitis is defined by ongoing inflammation and resultant activation of _____ cells –> fibro-inflammatory response
Stellate cells
Most common causes of Chronic Pancreatitis include ____ and _____ use, hyper_____, hyper______, and CKD.
Alcohol and Tobacco use
Hypercalcemia
Hypertriglyceridemia
Chronic pancreatitis is more common in ____ (gender) and in _____ (race). It is most common between the ages of 45-54.
Males
Blacks
Pancreatic ______ on Xray are highly specific for Chronic pancreatitis, but they are only seen in about 30% of cases.
The most common tests used to diagnose chronic Pancreatitis are ___/_____ or EUS (endoscopic ultrasound).
Calcifications
MRI/MRCP
The most common complication of Chronic Pancreatitis is formation of _______. Keep in mind Chronic Pancreatitis is a risk factor for _____ _____.
Pseudocysts (25% of cases)
Pancreatic Cancer
The most important treatment for Chronic Pancreatitis is cessation of ____ and ____ use.
EtOH and Tobacco use
Two of the Genetic risk factors for Pancreatic Adenocarcinoma are ____-_____ syndrome and ______ germline mutations. The overall 5-year survival rate is < ___%.
Peutz-Jeghers syndrome
BRCA2
<6%
Compared with other malignancies, Pancreatic Adenocarcinoma patients present with high rates of ______. Also be on the lookout for adult patients presenting with newly onset ______.
Depression
Diabetes
The most common method of diagnosis for Pancreatic Adenocarcinoma is ____ or _____ imaging. EUS guided Fine Needle Aspiration (FNA) or ERCP w/brushing and biopsy can be used as well.
CT or MRI
_____ _____ is the only curative treatment for patients with Pancreatic Adenocarcinoma that has NOT metastasized. Otherwise, Preoperative _____ and/or Radiation therapy are used for patients with locally advanced disease.
Surgical Resection
Chemo
The vast majority of Gallstones are comprised mainly of ____.
< 10% of gallstones are Pigmented. What are black and brown stones comprised of?
Cholesterol
Black –> polymerized calciumbilirubinate
Brown –> monomeric calciumbilirubinate
If bilirubin is a component, this likely suggests the stones are found in the LIVER!
Which gender is at higher risk for gallstones?
Females
_____ infection is one of the key component for pigmented gallstone formation.
Bacterial
The vast majority of gallstone patients are ________ and require no treatment. Treatment is ONLY indicated in symptomatic patients or patients presenting with _______ gallbladder.
Treatment is ______ within 2 weeks of biliary colic.
Asymptomatic
Porcelain
Cholecystectomy
____ scan is the most sensitive and specific test for Acute Cholecystitis.
HIDA (it’s a type of scintigraphy)
How does the formation and composition of Bile Duct stones differ in Western vs Easter/Asian populations?
Western –> Mostly formed in gallbladder and composed of Cholesterol
Eastern/Asian –> form in the duct de novo and composed of pigment (usually from infection and/or stasis).
The vast majority of Bile Duct stone patients are ______ (symptomatic or asymptomatic?). How does this compare to gallbladder stone patients?
Symptomatic
So this is the OPPOSITE of gallbladder stone patients.
Diagnosis of bile duct stones is confirmed with elevation in ____/____. Normal LFTs within ___hrs after the onset of pain rules OUT bile duct stones with an NPV of 95-98%.
EUS and MRI are used to diagnose, but which one can detect stones < 5cm?
What is the gold standard for diagnosis and treatment combo?
AST/ALT
24hrs
EUS can detect stones < 5cm
ERCP
Patients who receive papillotomy for bile duct stones should alse receive _____ within 72hrs of treatment.
Cholecystectomy
Biliary _____ is the treatment for Acute Cholangitis, as antibiotics have no definitive effect. This treatment should be delivered within ____hr for unstable patients and within ____hrs for stable patients.
Decompression
6hrs
24hrs
Intrahepatic Cholangiocarcinoma is the ____ (least or most?) common type of Cholangiocarcinoma.
Least
_____ _____ _____ is the MOST important risk factor for Cholangiocarcinoma (specifically for perihilarcholangiocarcinoma pCC)
Primary Sclerosing Cholangitis
Though surgery is curative, why is it only successful in < 30% of Cholangiocarcinoma patients?
The disease is typically too advanced at the time of presentation.
