Pancreas Mcgowen Flashcards
ARDS on radiograph
bilateral diffuse fluffy infiltrates
normal cardiac size
what conversion results in autodigestion of pancreas and peri pancreaetic tissue
trypsinogen to trypsin
etiology of acute pancreatitis
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
making diagnosis of acute pancreatitis
at least 2 of 3
epigastric pain
lipase and amhlase 3X ULN
CT canges consistent with pancreatitis
AP and calccium
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
lipase or amylase more acutreate measurement in AP
lipase
other factors AP
smoking
high glycemic load
abdominal adiposity
older and fat person
what can help prevent AP
veggies
maybe statins
RANSON criteria assessing severity of acute pancreatiis
GA LAW
Glucose over 200 age over 55 LDH over 350 AST over 250 WBC >16,000
RANSON criteria 48 hours after admision
C & HOBBS
calcium hematocrit drop oxygen under 60 mm hg base deficit BUN increase over 5 sequestion of fluid > 6L
number of criteria and mortality rate for ranson
0-2, 1%
3-4, 16%
5-6, 40%
7-8, 100
apache II score over what means higher mortallity
8
BISAP score
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
what is independely associated with increased mortality in AP
SIRS and elevated BUN on admission with rise in BUN w in first 24 hours of hospitalization
HAPS score
non severe course
no abdom tenderness or guarding
normal hematocrit
normal serum creatinine
atlanta criteria
mild- no organ failure or compolications
moderate- transient organ failure <48 hrs, local complications
sever: persistent organ failure over 48 hours
local complications in atlanta criteria
acute pancreatic fluid colection
pancreatic pseudo cyst
acute necrotic collection
pleural effusion
organ failure atlanta
respiratory, cardiac, renal
cullens sign
ecchymosis of umnblilicus from retroperitoneum fluid and bleeding
imaging in AP
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)
procedures for necrotizing pancreatitis
3rd day
ct guided needle aspiration
and antiobiotics
how do you drain a pseudocyst
EUS
complications of severe acute pancreatitis
intravascular volume depletion (pre renal azotemia)
necrosis (walled off)
pseudocyst (encap fluid with lots of amylase) can become abscess
ARDS
pancreatic ascites
risk factors in SAP for high levels of fluid sequestration
younger age alcohol etiology higher hematocrit higher serum glucose w/in 48 hrs hospital admission SIRS w/in 48 hours hospital admission
SHAAG
post ERCP prophylaxis for AP
NSAIDs
indomethacin rectally and aggressive hydration with IVF using lactated ringers
tx of SAP
within 48 hours of admission start enteral feedings with nasogastric or nasojejunal tue
reduces risk of multiorgan fialure and mortality
etiology of chronic pancreatitis
TIGAR-O
toxic-metabolic idiotpathic genetic autoimmune (hypergammaglobuminemia IgG4) recurrent (from recurrent AP) obstructivre
SAPE
hypothesis of pathogenesis of chronic pancreattiis
-first acute pancreatitis event initates an inflammatory process that results in injury and later fibrosis
pacnreatic fnct tests
trypsinogen
fecal elastase
-both low
pancreatic malabsorption
stimulation tests with CCK/secretin
CT: tumefactive chronic pancreatitis =
concern for pancreatic cancer
plain x ray for CP
calcifications
CT may show it if not on xray
seeing autoimmune pancreatitis
EUS,
diffuse enlargement of pancreas, a peripheral rim of hypoattentuation, and irregular narrowing of main PD
can you get osteoporis with CP?
what about peptic ulcer
yes to both
exocrine pancreatic insufficiency
confirmed by response to therapy with pancreatic enzyme supps
secretin stimulation test
decreased chymotrpysin or fecal elastase
main cause of death in CP
pancreatic Cancer
pancreatic neuroendocrine tumors and MEN
found in MEN 1
insulinoma, hypoglycemia
gastrinoma, multiple peptic ulcers, most found duodenum next most is pancreas
MEN1
pituitary
-acromegaly, cushing
parathyroid
-hypercalcemia
pancreas
- gastrinoma ZE
- insulinoma
men 2A
parathyroid
adrenal (pheochromocytoma)
thyroid (medullary thyroid ca)
-elevated calcitonin
-2-5 percent get hirscpurngs
MEN 2B
marfanoid body habitus medullary thyroid cancer (inreased calcitonin) pehochromocytomas neuromas -freq new gene mutation
