Lecture 9 - Acute & Chronic Pancreatitis

Question 1

I GET SMASHED pneumonic causes of acute pancreatitis

Answer 1

Idiopathic
Gallstones
Ethanol
Tumors
Scorpion stings
Microbio
Autoimmune
surgery/trauma
Hyperlipidemia
Emboli/ischemia
Drugs/toxins

Question 2

Most common acute pancreatitis causes

Answer 2

Biliary tract disease = 40-70%
Alcohol = 25-35%

Question 3

Acute pancreatitis clinical presentation

Answer 3

Ab pain
Nausea & Vomiting
Respiratory distress
Shock
Coma
Epigastric Tenderness
Absent/dec bowel sounds
Jaundice
altered mental status

Question 4

Drugs to look for for medication-induced pancreatitis

Answer 4

PPI/H2a?
Drug inc risk of hypertriglyceridemia
Antimicrobia
steroids
diuretics
Valproic acid
Immunosuppresants
chemo drugs

Rare to be the cause

Question 5

Ranson’s criteria

Answer 5

helps predict mortality
higher the score = higher mortality

Question 6

Acute pancreatitis treatment

Answer 6

Fluid replacement, initially with lactated rigers
Corect electrolytes
Treat metabolic abnormalities
Pain control

Question 7

If treating pancreatitis with antibiotics

Answer 7

start within 48hrs of infection
need to penetrate necrosis, duration 2-3 weeks

Question 8

Antibiotics used for acute pancreatic

Answer 8

Cover Gram - and Anaerobes

carbapenems: Imipenem/cilastin, meropenem
Cipro/Levo + metronidazole
Cefotaxime, ceftazidime/cefepime + metronidazole, pip/tazo, ofloxacin

Antifungal if necessary

Question 9

Chronic pancreatitis often caused by…

Answer 9

alcohol = 70%
Idiopathic = 20%
Other = 10%

Cig smoking contributes to mortality

Question 10

Chronic Pancreatitis pneumonic….TIGARO

Answer 10

Toxic-metabolic
Idiopathic
Genetic
Autoimmune
Recurrent and severe acute pancreatitis
Obstructive

Question 11

Chronic vs acute pancreatitis?

Answer 11

Steatorrhea = fatty stools

Question 12

Non-pharm treatment chronic pancreatitis

Answer 12

Alcohol and tobacco cessation

Diet = small/freq meals, hydration, vitamin and mineral supplementation, feeding tube if severe malnutrition

Surgery

Question 13

if given non-EC pancreatic enzyme, then need to give it with a…

Answer 13

PPI

Question 14

how to dose pancreatic enzymes?

Answer 14

weight based dosing, start 500mg/kg/meal
done based on lipase
dont recommande >75,000 units

Question 15

Lyme disease caused by….

Answer 15

Borrelia burgdorferi

Question 16

Lyme disease transmitted by

Answer 16

Blacklegged and Westertern blacklegged tick

found upper midwestern/notheastern US

most common tick-borne illness

Question 17

Early localized disease for Lyme disease

Answer 17

erythema migrans
flu-like symptoms
lymphadenopathy

Question 18

Late disseminated disease for Lyme disease

Answer 18

multiple rashes
flu-like symptoms
laundry list of shit

Question 19

How to diagnosis Lyme disease

Answer 19

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

Question 20

two-tiered testing for Lyme

Answer 20

EIA or IFA, if positive you do western Blot depending on if symptoms < 30 or > 30 days

Question 21

Early Lyme disease treatment

Answer 21

Doxy 100 BID for 14 days = adults
Doxy 4.4mg/kg/day in 2 doses, 200mg max = children 14 days too

Question 22

Alternatives for Early Lyme disease treatment

Answer 22

Macrolides for both adults and childrens

Question 23

What to use for severe manifestations of early Lyme disease?

Answer 23

IV ceftriaxone, higher doses than normal of doxy

Question 24

Treatment for late Lyme disease

Answer 24

ceftriaxone IV usually higher dose or longer treatment duration
NSAIDs for pain

Question 25

Post-lame disease

Answer 25

not really medically accepted
dont use ABX

Question 26

Babesiosis info

Answer 26

transmitted by backlogged tick
mostly found in upper midwestern and northeastern US

Question 27

Babesiosis diagnosis

Answer 27

most pts with clinical manifestations of infection dont require treatment unless parasites seen on blood smear for > 30 days

Question 28

Babesiosis Treatment Adults/children

Answer 28

Atovaquone + Azithromycin
or
Clindaymycin + quinine
Both 7-10 days

Question 29

Severe babesiosis treatment if parasitemia > 10% and/or organ dysfunction then typically receive…..

Answer 29

Clindamycin + quinine

Question 30

Human Granulocytic anaplasmosis

Answer 30

upper midwest and northeastern US
** dont delay therapy waiting on lab results **

Question 31

Anaplasmosis Treatment

Answer 31

Doxy 10-14days for adults/children < 100lbs
Rifampin Bid = pregnancy/allergy

Question 32

Rocky Mountain spotted fever

Answer 32

most found in southern US
Transmitted Dermacentor

Rash = spotty

Question 33

Rocky Mountain spotted fever treatment

Answer 33

Doxycycline

Question 34

Tularemia

Answer 34

ulcer at infection site = tell tale symptom

Transmitted by dog,wood and lonestar tick

mostly in midwest/plain states but pretty spread out

Question 35

Tularemia treatment

Answer 35

Streptomycin but usually doxy is used (not recommended children)

Adult: Strep, doxy, gent, cipro
Children: strep, gen, cipro

Min 10 day therapy

Question 36

Tick prevention tips

Answer 36

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

Question 37

Single-dose of doxy after high risk tick bite for Lyme disease prevention for….

Answer 37

non preg adults = 200mg
Children any age, 4.4mg/kg if < 45kg

Question 38

Conditions for Lyme disease prevention doxy

Answer 38

1. where bite occurred? likely to be tick that carries lyme
2. tick removed within last 72hrs
3. was tick body engorged w/ blood (not flat)
4. was tick a blacklegged tick?
5. is doxy safe for patient
6. doxy is not CI?