Pancreas Mcgowen

Question 1

ARDS on radiograph

Answer 1

bilateral diffuse fluffy infiltrates

normal cardiac size

Question 2

what conversion results in autodigestion of pancreas and peri pancreaetic tissue

Answer 2

trypsinogen to trypsin

Question 3

etiology of acute pancreatitis

Answer 3

gallstone
alcohol

hyperTGs
trauma
meds
ERCP
celiac, vaculitis
mumps, CMV, MAC
peritoneal dialysis
bypass
balloon enteroscopy
pancreatic divism
CFTR
union of pancreatobuiliary duct
neoplasm
corpion sting in trinidad
idiotpathic

Question 4

making diagnosis of acute pancreatitis

Answer 4

at least 2 of 3

epigastric pain
lipase and amhlase 3X ULN
CT canges consistent with pancreatitis

Question 5

AP and calccium

Answer 5

hypocalcemia
if have tetany than poor prognois
from interaction of cations with FFA released by action of activaged lipase on triglcerides in fat cells causes this = saponification

Question 6

lipase or amylase more acutreate measurement in AP

Answer 6

lipase

Question 7

other factors AP

Answer 7

smoking
high glycemic load
abdominal adiposity
older and fat person

Question 8

what can help prevent AP

Answer 8

veggies

maybe statins

Question 9

RANSON criteria assessing severity of acute pancreatiis

Answer 9

GA LAW

Glucose over 200
age over 55
LDH over 350
AST over 250
WBC >16,000

Question 10

RANSON criteria 48 hours after admision

Answer 10

C & HOBBS

calcium
hematocrit drop
oxygen under 60 mm hg
base deficit
BUN increase over 5
sequestion of fluid > 6L

Question 11

number of criteria and mortality rate for ranson

Answer 11

0-2, 1%
3-4, 16%
5-6, 40%
7-8, 100

Question 12

apache II score over what means higher mortallity

Answer 12

8

Question 13

BISAP score

Answer 13

bun over 25
impaired mental status
sirs
over 60
pleural effusion

0-5 scale, <1% when 0 to 1, up to 27% mortality at 5

Question 14

what is independely associated with increased mortality in AP

Answer 14

SIRS and elevated BUN on admission with rise in BUN w in first 24 hours of hospitalization

Question 15

HAPS score

Answer 15

non severe course

no abdom tenderness or guarding
normal hematocrit
normal serum creatinine

Question 16

atlanta criteria

Answer 16

mild- no organ failure or compolications

moderate- transient organ failure <48 hrs, local complications

sever: persistent organ failure over 48 hours

Question 17

local complications in atlanta criteria

Answer 17

acute pancreatic fluid colection
pancreatic pseudo cyst
acute necrotic collection
pleural effusion

Question 18

organ failure atlanta

Answer 18

respiratory, cardiac, renal

Question 19

cullens sign

Answer 19

ecchymosis of umnblilicus from retroperitoneum fluid and bleeding

Question 20

imaging in AP

Answer 20

sentinenl loop: segment of air filled SI in LUQ

colon cutof sign: gas filled segment of transverse colon abruptly ending at area of pancreatic inflammation

rapid bolus IV contrast- enhanced CT (avoid when serum Cr over 1.5)

Question 21

procedures for necrotizing pancreatitis

Answer 21

3rd day
ct guided needle aspiration
and antiobiotics

Question 22

how do you drain a pseudocyst

Answer 22

EUS

Question 23

complications of severe acute pancreatitis

Answer 23

intravascular volume depletion (pre renal azotemia)

necrosis (walled off)

pseudocyst (encap fluid with lots of amylase) can become abscess

ARDS

pancreatic ascites

Question 24

risk factors in SAP for high levels of fluid sequestration

Answer 24

younger age
alcohol etiology
higher hematocrit
higher serum glucose w/in 48 hrs hospital admission
SIRS w/in 48 hours hospital admission

SHAAG

Question 25

post ERCP prophylaxis for AP

Answer 25

NSAIDs

indomethacin rectally and aggressive hydration with IVF using lactated ringers

Question 26

tx of SAP

Answer 26

within 48 hours of admission start enteral feedings with nasogastric or nasojejunal tue
reduces risk of multiorgan fialure and mortality

Question 27

etiology of chronic pancreatitis

Answer 27

TIGAR-O

toxic-metabolic
idiotpathic
genetic
autoimmune (hypergammaglobuminemia IgG4)
recurrent (from recurrent AP)
obstructivre

Question 28

SAPE

Answer 28

hypothesis of pathogenesis of chronic pancreattiis

-first acute pancreatitis event initates an inflammatory process that results in injury and later fibrosis

Question 29

pacnreatic fnct tests

Answer 29

trypsinogen
fecal elastase
-both low

pancreatic malabsorption
stimulation tests with CCK/secretin

Question 30

CT: tumefactive chronic pancreatitis =

Answer 30

concern for pancreatic cancer

Question 31

plain x ray for CP

Answer 31

calcifications

CT may show it if not on xray

Question 32

seeing autoimmune pancreatitis

Answer 32

EUS,

diffuse enlargement of pancreas, a peripheral rim of hypoattentuation, and irregular narrowing of main PD

Question 33

can you get osteoporis with CP?

what about peptic ulcer

Answer 33

yes to both

Question 34

exocrine pancreatic insufficiency

Answer 34

confirmed by response to therapy with pancreatic enzyme supps

secretin stimulation test

decreased chymotrpysin or fecal elastase

Question 35

main cause of death in CP

Answer 35

pancreatic Cancer

Question 36

pancreatic neuroendocrine tumors and MEN

Answer 36

found in MEN 1
insulinoma, hypoglycemia

gastrinoma, multiple peptic ulcers, most found duodenum next most is pancreas

Question 37

MEN1

Answer 37

pituitary
-acromegaly, cushing

parathyroid
-hypercalcemia

pancreas

• gastrinoma ZE
• insulinoma

Question 38

men 2A

Answer 38

parathyroid

adrenal (pheochromocytoma)

thyroid (medullary thyroid ca)
-elevated calcitonin

-2-5 percent get hirscpurngs

Question 39

MEN 2B

Answer 39

marfanoid body habitus
medullary thyroid cancer (inreased calcitonin)
pehochromocytomas
neuromas
-freq new gene mutation