Pancreas CIS Flashcards
criteria to dx acute pancreatis
(2 out of the 3)
- lipase level 3x the ULN
- epigastric pain
- changes on CT
acute pancreatitis- etiolgoy
- gallstones
- heavy alcohol use
- hypertriglyceridemia
- trauma
- ERCP
saponification
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!!
amylase- elevated in other conditions
- high intestinal obstruction
- gastroenteritis
- mumps
- ectopic pregnancy
- opioids
- after abd surgery
acute pancreatitis- severity assessment
- Ranson criteria
- apache II (>8= higher mortality)
- atlanta classification
- CT grade of severity index
acute pancreatitis- independtly assoc with inc mortality
-SIRS and elevated BUN on admission with a rise in BUN within first 24 hrs of hospitalization
Ranson criteria- 3 or more- severe course with pancreatic necrosis
(acute pancreatitis) GA-LAW- at admission -Glucose >200 -Age>55 -LDH> 350 -AST >250 -WBC > 16,000
Ranson criteria- development of the following in the first 48 hrs indicates a worsening prognosis
C & HOBBS (48 hrs after admission)
- Calcium < 8
- Hematocrit drop > 10%
- oxygen (paO2) < 60
- Base deficit > 4
- BUN increase > 5
- sequestration of fluid > 6L
Ranson criteria- number of criteria and mortality rate
- 0-2- 1%
- 3-4- 16%
- 5-6- 40%
- 7-8- 100%
Atlanta criteria
(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
acute pancreatitis- imaging signs- xray
- “sentinel loop”- air filled small intestine
- “colon cutoff sign”- gas filled segment of transverse colon abruptly ending at area of pancreatic infl
acute pancreatitis- unenhanced CT
-demonstrate enlarged pancreas when dx is uncertain
acute pancreatitis- rapid-bolus IV contrast-enhanced CT
- ID areas of pancreatic necrosis
- should be avoided when serum Cr > 1.5!!!
severe acute pancreatitis- complications
- intravascular volume depletion
- pleural effusion
- necrosis
- pseudocysts
- ARDS
risk factors in SAP for high levels of fluid sequestration
- younger age
- alcohol etiology
- higher hematocrit value
- higher serum glucose within 48 hrs of admission
- SIRS
acute pancreatitis- treat the cause
- alcoholic- abstinence
- gallstone
- hypertriglyceridemia
- post ERCP prophylaxis
mild acute pancreatitis- tx
- 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
severe acute pancreatitis- tx
- 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!!!
acute pancreatitis- CT grade
- 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
chronic pancreatitis- imaging- main sign
-calcifications in epigastric region
pancreatic cancer- sx, imaging sign
- painless jaundice, hyperbilirubinemia
- tumefactive chronic pancreatitis
chronic pancreatitis- etiology- mnemonic
TIGAR-O
- toxic-metabolic (alcoholic)
- idiopathic
- genetic- CFTR, PSTI, SPINK1, PRSS1
- autoimmune- IgG4
- recurrent
- obstructive
sentinel acute pancreatitis event
- pathogenesis of chronic pancreatitis
- event that initiates infl process- results in injury and then fibrosis
pancreatic fxn tests
- trypsinogen- low in insufficiency
- fecal elastase- low in insufficiency
- pancreatic malabsorption
- stimulation tests (CCK, secretin)
chronic pancreatitis- imaging
- xray- calcifications
- CT- calcification, ductal dilation
- ERCP
- EUS
chronic pancreatitis- complications
- DM
- pseudocyst or abscess
- bile duct stricture
- pancreatic insufficiency- steatorrhea, malnutrition
- osteoporosis
- pancreatic CA
pancreatic insufficiency- tests
- secretin stim test
- response to therapy with pancreatic enzyme supplements
- dec fecal chymotrypsin
- dec pancreatic fecal elastase
chronic pancreatitis- main cause of death
pancreatic cancer
most common place for gastrinoma
- duodenum!
- pancreas- second most common
MEN1
-pituitary adenoma- cushing
-parathyroid hyperplasia
-pancreas- tumors- gastrinoma, insulinoma
(PPP)
MEN2a
-thyroid- medullary thyroid cancer
-adrenal- pheochromocytoma
-parathyroid -parathyroid hyperplasia*
(TAP)
MEN2b
- marfans body habitus**
- neuromas of lips and tongue**
- medullary thyroid cancer- elevated calcitonin
- pheochromocytoma
