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G2F > Pancreas CIS > Flashcards

Pancreas CIS Flashcards

1
Q

criteria to dx acute pancreatis

A

(2 out of the 3)

  • lipase level 3x the ULN
  • epigastric pain
  • changes on CT
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2
Q

acute pancreatitis- etiolgoy

A
  • gallstones
  • heavy alcohol use
  • hypertriglyceridemia
  • trauma
  • ERCP
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3
Q

saponification

A

in acute pancreatitis!
-interaction of cations with free fa’s released by the action of activated lipase on triglycerides in fat cells–> low blood calcium!!

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4
Q

amylase- elevated in other conditions

A
  • high intestinal obstruction
  • gastroenteritis
  • mumps
  • ectopic pregnancy
  • opioids
  • after abd surgery
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5
Q

acute pancreatitis- severity assessment

A
  • Ranson criteria
  • apache II (>8= higher mortality)
  • atlanta classification
  • CT grade of severity index
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6
Q

acute pancreatitis- independtly assoc with inc mortality

A

-SIRS and elevated BUN on admission with a rise in BUN within first 24 hrs of hospitalization

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7
Q

Ranson criteria- 3 or more- severe course with pancreatic necrosis

A 
(acute pancreatitis)
GA-LAW- at admission
-Glucose >200
-Age>55
-LDH> 350
-AST >250
-WBC > 16,000
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8
Q

Ranson criteria- development of the following in the first 48 hrs indicates a worsening prognosis

A

C & HOBBS (48 hrs after admission)

  • Calcium < 8
  • Hematocrit drop > 10%
  • oxygen (paO2) < 60
  • Base deficit > 4
  • BUN increase > 5
  • sequestration of fluid > 6L
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9
Q

Ranson criteria- number of criteria and mortality rate

A
  • 0-2- 1%
  • 3-4- 16%
  • 5-6- 40%
  • 7-8- 100%
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10
Q

Atlanta criteria

A

(acute pancreatitis)

  • mild- no organ failure, no local complications (fluid, pseudocyst, necrosis, pleural effusion)
  • moderate- transient organ failure < 48 hrs, local complications +/-
  • severe- persistent organ failure > 48 hrs
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11
Q

acute pancreatitis- imaging signs- xray

A
  • “sentinel loop”- air filled small intestine

- “colon cutoff sign”- gas filled segment of transverse colon abruptly ending at area of pancreatic infl

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12
Q

acute pancreatitis- unenhanced CT

A

-demonstrate enlarged pancreas when dx is uncertain

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13
Q

acute pancreatitis- rapid-bolus IV contrast-enhanced CT

A
  • ID areas of pancreatic necrosis

- should be avoided when serum Cr > 1.5!!!

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14
Q

severe acute pancreatitis- complications

A
  • intravascular volume depletion
  • pleural effusion
  • necrosis
  • pseudocysts
  • ARDS
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15
Q

risk factors in SAP for high levels of fluid sequestration

A
  • younger age
  • alcohol etiology
  • higher hematocrit value
  • higher serum glucose within 48 hrs of admission
  • SIRS
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16
Q

acute pancreatitis- treat the cause

A
  • alcoholic- abstinence
  • gallstone
  • hypertriglyceridemia
  • post ERCP prophylaxis
17
Q

mild acute pancreatitis- tx

A
  • 80% resolve w/o complications
  • pancreas rest- NPO, bed rest, NG suction for ileus
  • fluid resuscitation
  • pain control
  • once pain free and BS- resume oral intake
18
Q

severe acute pancreatitis- tx

A
  • necrotizing- leakage of fluids- larger amts of IVF
  • hemodynamic monitoring in ICU
  • give calcium gluconate IV- for hypocalcemia with tetany
  • serum albumin infusions for hypoalbuminemia
  • shock- use pressors if fluids arent helping
  • within 48 hrs- start enteral feedings with nasogastric tube- reduces risk of multiorgan failure and mortality!!!
19
Q

acute pancreatitis- CT grade

A
  • normal pancreas- 0
  • pancreatic enlargement- 1- 0% mortality rate
  • pancreatic infl and/or peripancreatic fat- 2; necrosis < 30%- <3% mortality rate
  • single acute peripancreatic fluid collection- 3- necrosis 20-50%- 6% mortality rate
  • 2 or more peripancreatic fluid collections or retroperitoneal air- 4- necrosis >50%- >17% mortality rate
20
Q

chronic pancreatitis- imaging- main sign

A

-calcifications in epigastric region

21
Q

pancreatic cancer- sx, imaging sign

A
  • painless jaundice, hyperbilirubinemia

- tumefactive chronic pancreatitis

22
Q

chronic pancreatitis- etiology- mnemonic

A

TIGAR-O

  • toxic-metabolic (alcoholic)
  • idiopathic
  • genetic- CFTR, PSTI, SPINK1, PRSS1
  • autoimmune- IgG4
  • recurrent
  • obstructive
23
Q

sentinel acute pancreatitis event

A
  • pathogenesis of chronic pancreatitis

- event that initiates infl process- results in injury and then fibrosis

24
Q

pancreatic fxn tests

A
  • trypsinogen- low in insufficiency
  • fecal elastase- low in insufficiency
  • pancreatic malabsorption
  • stimulation tests (CCK, secretin)
25
Q

chronic pancreatitis- imaging

A
  • xray- calcifications
  • CT- calcification, ductal dilation
  • ERCP
  • EUS
26
Q

chronic pancreatitis- complications

A
  • DM
  • pseudocyst or abscess
  • bile duct stricture
  • pancreatic insufficiency- steatorrhea, malnutrition
  • osteoporosis
  • pancreatic CA
27
Q

pancreatic insufficiency- tests

A
  • secretin stim test
  • response to therapy with pancreatic enzyme supplements
  • dec fecal chymotrypsin
  • dec pancreatic fecal elastase
28
Q

chronic pancreatitis- main cause of death

A

pancreatic cancer

29
Q

most common place for gastrinoma

A
  • duodenum!

- pancreas- second most common

30
Q

MEN1

A

-pituitary adenoma- cushing
-parathyroid hyperplasia
-pancreas- tumors- gastrinoma, insulinoma
(PPP)

31
Q

MEN2a

A

-thyroid- medullary thyroid cancer
-adrenal- pheochromocytoma
-parathyroid -parathyroid hyperplasia*
(TAP)

32
Q

MEN2b

A
  • marfans body habitus**
  • neuromas of lips and tongue**
  • medullary thyroid cancer- elevated calcitonin
  • pheochromocytoma

G2F (17 decks)

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