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Surgery > Pancreas > Flashcards

Pancreas Flashcards

1
Q

pt px w/ epigastric pain radiating to back
elevated lipase/amylase
what imaging do you get first?

A

U/S

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2
Q

In Pancreatitis an Elevated __ is the worst prognosis

A

BUN

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3
Q 
Common causes of acute pancreatitis:
(3)
Hypercalcemia
Post-\_\_\_\_
Scorpion stings
Infections (CMV)
Drugs (valproate, thiazides)
A

Alcohol use
Gallstones
Hyper Triglyceridemia
Post- ERCP

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4
Q 
Diagnosis of Acute Pancreatitis requires 2 of the following
1. \_\_
2. \_\_
3. On u/s enlarged pancreas 
On abdominal x-ray:
Sentinel loop sign
Colon cut off sign
A
  1. Acute epigastric pain radiating to the back

2. Amylase or Lipase 3x> normal

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5
Q

ALT > ___ suggests gallstone pancreatitis

A

150

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6
Q

__ is characterized by intermittent epigastric pain that radiates to the back and worsens after meals.
+/- steatorrhea
+/- h/o Diabetes

A

Chronic pancreatitis

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7
Q

Chronic pancreatitis

Imaging demonstrates pancreatic atrophy and __, in some cases.

A

calcifications

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8
Q

Management of chronic pancreatitis

A

Pancreatic enzyme supplementation

(lipase, protease, amylase)
is used to treat both exocrine insufficiency and pain

(smoking/etoh cessation)

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9
Q

3 causes of chronic pancreatitis

  1. ___
  2. ___
  3. Autoimmune
A
  1. Alcohol/Tobacco use

2. Cystic Fibrosis

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10
Q

___ is a rare complication of chronic pancreatitis that results from damage to the pancreatic duct, leading to leakage of pancreatic juice into the peritoneal space.

A

Pancreatic ascites

Like ascites from other causes, sxs include abdominal distension, dyspnea, and early satiety

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11
Q

Pt presents with epigastric TTP & early satiety
Physical exam significant for shifting dullness & fluid wave.
Serum albumin is low at 3.4 mg/dL.
Paracentesis reveals serosanguinous fluid showing high
levels of total protein & amylase.
Diagnosis

A

Pancreatic ascites

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12
Q

___ is the most common complication after ERCP

A

Acute pancreatitis

Order Amylase & Lipase levels first

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13
Q

Pancreatic ___ is an encapsulated area (composed of enzyme-rich fluid, tissue, and debris) that causes an inflammatory response.

A

pseudocyst

Diagnosis is confirmed by abdominal imaging

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14
Q

For pts w/ pancreatic pseudocyst & minimal or no symptoms and without complications __ management is preferred.

A

expectant

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15
Q

This procedure is typically reserved for patients w/ pancreatic pseudocyst & significant symptoms:
(abdominal pain, vomiting),
infected pseudocyst,
or evidence of pseudoaneurysm.

A

Endoscopic drainage

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16
Q

Initial management in pts with acute pancreatitis presenting with epigastric pain and vomiting includes
(4)

A

NPO
IVF
NGT
Analgesia (NSAIDS; Opioids)

  • Early oral feeding (w/in 24 hrs) as tolerated or Enteral tube (nasogastric or nasojejunal)
  • If s/t gallstones → ERCP (within < 24 hours indicated if concurrent cholangitis) → cholecystectomy
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17
Q

Pancreatic ___ can be 2/2 Acute Pancreatitis or abdominal trauma

It can eventually progress to ___ or ___

A

abscess
pancreatic pseudocyst
chronic pancreatitis

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18
Q

Edematous pancreatitis commonly occurs 2/2 alcohol use or post ___

A

Laryngeal interventions

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19
Q

Type of pancreatitis that presents with:

  1. ↑ HCT
  2. ↓ HCT
A
  1. Edematous

2. Hemorrhagic

20
Q

Pancreatic abscess or necrosis seen on CT

What is the first and second step in management?

A

First: ABxs
Second: Drain (percutaneous/open)

21
Q

Pancreatic ___ can be 2/2 Acute Pancreatitis or abdominal trauma.

It presents weeks after acute pancreatitis, deep mass, early satiety, and abdominal pain.

A

Pseudocyst

22
Q

In Pancreatic Pseudocysts
Get U/S or CT

If ≤6cm & ≤6 weeks old → ____

If >6cm & >6 weeks old → ____

A

Observe

Percutaneous drainage

23
Q

Chronic Pancreatitis commonly 2/2 multiple pancreatic episodes.

Management includes:

A

Insulin
Pancreatic Enzyme replacement
+/- MRCP (drain pancreatic duct)

24
Q

In hemorrhagic pancreatitis obtain daily ___ and start the patient on ___

A

CT scans

Abxs

25
Q

Gallstone Pancreatitis presents with sxs of cholangitis and elevated amylase/lipase.
Obtain U/S
Initial management includes (3) followed by ___

A

NPO, NGT, IVFs
Cholecystectomy

(+/-) ERCP or sphincterotomy

26
Q

Skin changes (rare)
Cullen sign: periumbilical ecchymosis and discoloration
Grey Turner sign: flank ecchymosis with discoloration
Fox sign: ecchymosis over the inguinal ligament

suggest what diagnosis

A

Acute Pancreatitis

27
Q

_____ in the first 12–24 hours has the greatest impact on the clinical outcome of patients with acute pancreatitis.

A

IVF resuscitation

28
Q

___ are not recommended in acute pancreatitis, and should only be used in pts with evidence of infected necrosis.

A

Prophylactic antibiotics

29
Q

Bowel rest is no longer routinely recommended for acute pancreatitis.
___ nutrition should be initiated as early as tolerated.
Ideally within 24 hrs.

A

Enteral (via oral or enteral tube/NGT)

30
Q

Urgent __ is not indicated in acute gallstone pancreatitis unless acute cholangitis is present.

A

ERCP

*Cholecystectomy in all pts to prevent recurrence

31
Q

What lung manifestation can occur in acute pancreatitis?

A

Pleural effusion and/or ARDS

32
Q

In Chronic Pancreatitis ↓ ___ confirms steatorrhea is due to pancreatic lipase insufficiency

A

Fecal elastase-1

33
Q

Analgesics used for pancreatitis include
NSAIDs &
Opioids (fentanyl or ___)
for severe pain

A

hydromorphone

34
Q

Necrotizing pancreatitis
necrosis of pancreatic tissue

Clinical features:
Fever, persistent tachycardia, or insufficient symptomatic ___ over several days

Treatment
Can usually be managed conservatively
Encourage enteral nutrition if feasible.

A

improvement

Necrostomy is severe

35
Q

Infected necrotizing pancreatitis
Bacterial superinfection of necrotic pancreatic parenchyma

Clinical features:
persistent or worsening leukocytosis, bacteremia, & inflammatory markers
CT abdomen: gas or fluid around/in the pancreas

Treatment:

A

Antibiotics

Drain is clinical deterioration or no improvements w/Abxs

36
Q

A STEP-wise approach to diagnosing chronic pancreatitis may include: Survey, Tomography/imaging, Endoscopic imaging, and Pancreatic function testing.

A

Abdominal CT (with and without contrast) or MRCP/MRI

37
Q

Pancreatic enzyme levels are often normal in ____ and cannot be used to confirm or rule out the diagnosis.

A

chronic pancreatitis

*Acute pancreatitis always causes significant enzyme elevation.

38
Q

Complication of chronic pancreatitis

Encapsulated collection of pancreatic fluid that develops 4 weeks after an acute attack of pancreatitis

+/- Features:
Painless abdominal mass
Gastric outlet obstruction (early satiety, NB emesis, abd pain)

A

Pancreatic pseudocysts

*Splenic vein thrombosis is another cx

39
Q

Courvoisier sign: enlarged, nontender gallbladder and painless jaundice
&
Trousseau syndrome: superficial thrombophlebitis

suggests what pancreatic cause?

A

pancreatic cancer

  • MCC: ductal adenocarcinoma (95%)
  • Lymphatic & Hematogenous spread
40
Q

Double-duct sign

Increasing size of ___ tumor may block bile drainage in the CBD & pancreatic duct leading to dilatation of both.

A

pancreatic head

41
Q

Pancreatic head carcinoma treatment:

A

Pancreaticoduodenectomy (Whipple procedure)

*Resection of the pancreatic head, distal stomach (antrum/pylorus), duodenum, proximal jejunum, gallbladder, CBD, lymphadenectomy, and reconstruction via Roux-en-Y.

42
Q

Pancreatic body and tail carcinoma treatment:

A

Resection of the pancreatic body & tail with splenectomy

*In some cases, Duodenum is resected also

43
Q

Palliative approach to pancreatic cancer:

  1. Pain management: opioids
  2. _____: for symptomatic metastasis, especially to the brain and bones
  3. _____: when pain management fails
A
  1. Radiotherapy

3. Celiac ganglion/plexus block

44
Q

2 indications for Whipple’s Procedure

Pancreaticoduodenectomy

A
  1. Periampullary tumors

2. Chronic pancreatitis

45
Q

[Procedure] is recommended in patients with gallstone pancreatitis who have cholangitis, visible common bile duct dilation/obstruction, or increasing liver enzyme levels.

A

Endoscopic retrograde cholangiopancreatography (ERCP)

*Allows for cannulation and sphincterotomy to relieve the obstruction.

46
Q

A pancreaticopleural fistula (between the pancreatic duct and the pleural space) resulting in an amylase-rich exudative pleural effusionoccurs most commonly as a result of _____.

A

acute or chronic pancreatitis

Management includes bowel rest to promote fistula closure +/- ERCP

47
Q

Imaging study performed in all patients with suspected gallstone-induced pancreatitis.

A

Abd U/S

Surgery (36 decks)

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