Lecture 9 - Acute & Chronic Pancreatitis Flashcards
I GET SMASHED pneumonic causes of acute pancreatitis
Idiopathic
Gallstones
Ethanol
Tumors
Scorpion stings
Microbio
Autoimmune
surgery/trauma
Hyperlipidemia
Emboli/ischemia
Drugs/toxins
Most common acute pancreatitis causes
Biliary tract disease = 40-70%
Alcohol = 25-35%
Acute pancreatitis clinical presentation
Ab pain
Nausea & Vomiting
Respiratory distress
Shock
Coma
Epigastric Tenderness
Absent/dec bowel sounds
Jaundice
altered mental status
Drugs to look for for medication-induced pancreatitis
PPI/H2a?
Drug inc risk of hypertriglyceridemia
Antimicrobia
steroids
diuretics
Valproic acid
Immunosuppresants
chemo drugs
Rare to be the cause
Ranson’s criteria
helps predict mortality
higher the score = higher mortality
Acute pancreatitis treatment
Fluid replacement, initially with lactated rigers
Corect electrolytes
Treat metabolic abnormalities
Pain control
If treating pancreatitis with antibiotics
start within 48hrs of infection
need to penetrate necrosis, duration 2-3 weeks
Antibiotics used for acute pancreatic
Cover Gram - and Anaerobes
carbapenems: Imipenem/cilastin, meropenem
Cipro/Levo + metronidazole
Cefotaxime, ceftazidime/cefepime + metronidazole, pip/tazo, ofloxacin
Antifungal if necessary
Chronic pancreatitis often caused by…
alcohol = 70%
Idiopathic = 20%
Other = 10%
Cig smoking contributes to mortality
Chronic Pancreatitis pneumonic….TIGARO
Toxic-metabolic
Idiopathic
Genetic
Autoimmune
Recurrent and severe acute pancreatitis
Obstructive
Chronic vs acute pancreatitis?
Steatorrhea = fatty stools
Non-pharm treatment chronic pancreatitis
Alcohol and tobacco cessation
Diet = small/freq meals, hydration, vitamin and mineral supplementation, feeding tube if severe malnutrition
Surgery
if given non-EC pancreatic enzyme, then need to give it with a…
PPI
how to dose pancreatic enzymes?
weight based dosing, start 500mg/kg/meal
done based on lipase
dont recommande >75,000 units
Lyme disease caused by….
Borrelia burgdorferi
Lyme disease transmitted by
Blacklegged and Westertern blacklegged tick
found upper midwestern/notheastern US
most common tick-borne illness
Early localized disease for Lyme disease
erythema migrans
flu-like symptoms
lymphadenopathy
Late disseminated disease for Lyme disease
multiple rashes
flu-like symptoms
laundry list of shit
How to diagnosis Lyme disease
hx of travel to endemic area
risk factor for exposure to ticks
symptoms of early disseminated or late Lyme
run tests like elevated ESR, CSF, transaminitis, hematuria or proteinuria
two-tiered testing for Lyme
EIA or IFA, if positive you do western Blot depending on if symptoms < 30 or > 30 days
Early Lyme disease treatment
Doxy 100 BID for 14 days = adults
Doxy 4.4mg/kg/day in 2 doses, 200mg max = children 14 days too
Alternatives for Early Lyme disease treatment
Macrolides for both adults and childrens
What to use for severe manifestations of early Lyme disease?
IV ceftriaxone, higher doses than normal of doxy
Treatment for late Lyme disease
ceftriaxone IV usually higher dose or longer treatment duration
NSAIDs for pain
Post-lame disease
not really medically accepted
dont use ABX
Babesiosis info
transmitted by backlogged tick
mostly found in upper midwestern and northeastern US
Babesiosis diagnosis
most pts with clinical manifestations of infection dont require treatment unless parasites seen on blood smear for > 30 days
Babesiosis Treatment Adults/children
Atovaquone + Azithromycin
or
Clindaymycin + quinine
Both 7-10 days
Severe babesiosis treatment if parasitemia > 10% and/or organ dysfunction then typically receive…..
Clindamycin + quinine
Human Granulocytic anaplasmosis
upper midwest and northeastern US
** dont delay therapy waiting on lab results **
Anaplasmosis Treatment
Doxy 10-14days for adults/children < 100lbs
Rifampin Bid = pregnancy/allergy
Rocky Mountain spotted fever
most found in southern US
Transmitted Dermacentor
Rash = spotty
Rocky Mountain spotted fever treatment
Doxycycline
Tularemia
ulcer at infection site = tell tale symptom
Transmitted by dog,wood and lonestar tick
mostly in midwest/plain states but pretty spread out
Tularemia treatment
Streptomycin but usually doxy is used (not recommended children)
Adult: Strep, doxy, gent, cipro
Children: strep, gen, cipro
Min 10 day therapy
Tick prevention tips
Repalant w/ > 20% DEET, bunch other stuff
Treat clothes, tent,boots,etc w/ 0.5% permethrin
Treat animals with stuff
check for ticks daily
shower soon after being outside
Single-dose of doxy after high risk tick bite for Lyme disease prevention for….
non preg adults = 200mg
Children any age, 4.4mg/kg if < 45kg
Conditions for Lyme disease prevention doxy
- where bite occurred? likely to be tick that carries lyme
- tick removed within last 72hrs
- was tick body engorged w/ blood (not flat)
- was tick a blacklegged tick?
- is doxy safe for patient
- doxy is not CI?
