Mehlman pancreatitis (both), choled. cyst, liver hyperplasia 03-04 (3) Flashcards
gallstone pancreatitis. mechanism
stone obstructs HEPATOPANCREATIC AMPULA!!!!!!! (not stone in ductus choledocus)
stone itseft in ductus would not cause. it causes when obstructs ampulla.
gallstone pancreatitis. CP?
obstructive jaundice: incr. ALP + incr. direct bilirubin
+ incr. PANCREATIC ENZYMES (incr. amilase/lipase)
gallstone pancreatitis.
2 CK Dx?
DO CT of abdomen (not ERCP)
in this case we also look for fluid collection, not only stone
acute pancreatitis. presenctation cp+ lab?
abdominal pain + increased amylase and/or lipase
pain need not radiate to the back
acute pancreatitis. biggest risk factors?
what other 2 causes?
alcohol and gallstones
hyperlipidemia and hypercalcemia
acute pancreatitis. what drugs can cause?
didanosine is HIV NRTI;
exenatide is a GLP1 analogue for diabetes
yra Ranson criteria - to determine prognosis in pancreatitis. bet visu ju nereikia zinot. yra keli pointai.
.
Ranson to know.
what bad indicators?
decr. serum calcium and incr. glucose are bad prognostic indicators.
Ranson to know. what labs levers are not important?
degree of lipase/amylase elevations does not correlate with prognosis.
tipo ar 1200 ar 10k, pohuj visai for outcome
which is more specific for pancreatitis?
lipase more specific. but questions can only mension amylase, and nothing about lipase.
HY 2ck management triad?
- NPO (can be mentioned as bowel rest)
- NG decompression
- IV fluids with normal saline
management triad –> next best step?
after triad do CT abdomen scan
what to look for on abdomen CT scan?
fluid collection
abdomen CT scan –> fluids are present –>
do ERCP to drain this collection
fluid collection aka pseudocyst
what abs if needed? why?
carbapenems - have fantastic penetration of pancreatic tissue
- A 2CK NBME Q gives pancreatitis + CT scan su didele cista, and the
answer is just ERCP (for drainage of the pseudocyst within black circle).
UW yra tipo < 6cm + < 6 weeks - observe
jeigu > 6cm or > 6 weeks ERCP
mehlman nebuvo specifiskai pagal dydi
Acute pancreatitis yra HY cause of ARDS.
.
whats about necrosectomy?
what supplements?
A necrosectomy is removal of pancreatic tissue in the setting of high fraction of necrosis.
Patients with pancreatectomy require enzyme replacement (pancrelipase).
UW. diagnosis requires 2 of the following?
Acute epigastric pain (often radiating to back, bet nebutinai)
Amylase/lipase > 3 times normal limit
Abdominal image (CT) showing pancreatitis
UW CP. What is Cullen sign?
periumbilical bluish coloration indicating hemoperitoneum
UW CP. What is Grey-Turner sign?
Reddish-brown coloration around flanks indicating retroperitoneal bleed
UW CP. if ALT levels > 150 =?
its biliary pancreatitis
Chronic pancreatitis. indicating CP?
steatorrhea in alcoholics or inpatients with recurrent acute pancreatitis.
Chronic pancreatitis.
results in pancreatic burnout with –> production of pancreatic
enzymes –> decr. proteases/lipases
–> malabsorption.
.
Chronic pancreatitis. pancreatic enzyme level?
NORMAL!!!! ie. not elevated
Pancreas is exhausted
no enzymes –> malabsorbtion
Chronic pancreatitis. xylose test result?
D-xylose test is normal. This is a monosaccharide that is readily absorbed
by the small bowel insofar as the intestinal lining is intact. So if we get steatorrhea + normal D-xylose, this can be due to pancreatic insufficiency or lactose intolerance.
Chronic pancreatitis. steatorrhea + normal D-xylose?
can be due to pancreatic insufficiency or lactose intolerance.
Chronic pancreatitis. if steatorrhea + D-chylose ABNORMAL?
If D-xylose test is abnormal, we know the
malabsorption is due to an intestinal lining issue, such as Celiac or Crohn.
Chronic pancreatitis. usmle gives CT - what see?
calcifications
Chronic pancreatitis. Tx?
Pancreatic enzyme supplementation (pancrelipase)
dar is UW: smoking/alcohol cessation, pain management, frequent small meals
Sphincter of Oddi dysfunction. how case sounds?
- The answer on USMLE if the Q sounds like gallstone pancreatitis (i.e., ALP, direct bilirubin, pancreatic enzymes) but the patient hasn’t had a gallbladder for many years (so it can’t be a stone causing the obstruction).
Choledochal cyst. 2 ck surgery.
Case: incr. ALP, incr. direct bilirubin + CT scan cystic structure in biliary tree. what Tx?
simple cyst excision
Focal nodular hyperplasia. Case: adult + done abdominal CT (no specific reason why) = detected 1-2 cm lesion with CENTRAL SCAR in liver –> further Dx?
This is a lesion of hepatocellular hyperplasia that does not require
treatment. This is the answer on NBME, where they tell you CT shows hepatic lesion with central scar. Answer = “no further diagnostic studies indicated.”
