Pancreatic Diseases Flashcards

1
Q

What is acute pancreatitis?

A

Inflammatory disease

Autodigestion of the pancreas by protealytic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 main causes acute pancreatitis?

A

Alcohol
Gallstones
Together account for 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are mechanical causes of acute pancreatitis?

A

GALLSTONES
Blunt trauma
ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are other causes of acute pancreatitis?

A
Hypertriglyceridemia*
Hypercalcemia
Ischemia, vaculitis 
Viruses 
Genetic 
Idiopathic 30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does acute pancreatitis present?

A

Fever, ↑HR, +/- ↓BP, ↑RR

Jaundice

Hypoactive or absent BS
Mid epigastric tenderness

Cullen’s sign
Grey-Turner’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should your lab workup include for acute abd pain?

A

amylase & lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What imaging can you use to dx acute pancreatitis?

A
Plain films
US: gallstones
CT
MRCP
EUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are complications of acute pancreatitis?

A

Necrosis
Pseudocysts
Abscess
Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat acute pancreatitis?

A

NPO
IVF
Meperidine pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat pancreatitis when necrosis is a concern?

A

Imipenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are sx of a pancreatic pseudocyst?

A

Abd pain, early satiety, N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are systemic complications of pancreatitis?

A

Resp. failure/ARDS, pulmonary edema, pleural effusion, atelectasis

Renal failure

Hypotension/shock

GI

Metabolic: Hyper/hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are initial signs in Ranson’s criteria for pancreatitis?

A
>55 yo
WBC > 16000
Glucose > 200
AST > 250
LDH > 350
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the delayed signs in Ranson’s criteria for pancreatitis?

A
HCT drop > 10%
BUN increase > 5
Ca < 8
pO2 < 60
albumin < 3.2
Fluid sequestration 4-5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you treat biliary pancreatitis?

A

ERCP if CBD stone

Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is chronic pancreatitis? What does it lead to?

A

Repeated episodes of inflammation –> damage & ductal obstruction

Leads to exocrine & endocrine insufficiency

17
Q

What is the MC cause of chronic pancreatitis?

A

Alcohol (70-80%)

18
Q

How does chronic pancreatitis present?

A

Epigastric pain (80%)

Exocrine insufficiency –> malabsorption –> steatorrhea & wt loss

Endocrine insufficiency –> diabetes –> “poly” sx

19
Q

What is the classic triad of chronic pancreatitis?

A

Diabetes
Steatorrhea
Calcifications

20
Q

What labs do you use to dx chronic pancreatitis?

A

Amylase & lipase: normal or slightly elevated

Bilirubin & alk phos mildly elevated

Elevated glucose

Secretin stimulation test

Elevated fecal fat testing

21
Q

What imaging do you use to dx chronic pancreatitis?

A

Plain films: calcifications

CT: calcifications, ductal dilation, pseudocysts

MRCP

ERCP: “Chain-of-lakes”

22
Q

How do you treat chronic pancreatitis?

A

No more alcohol
Low fat meals
Insulin for DM
Pancreatic enzymes

23
Q

What meds can you use for pain relief from chronic pancreatitis?

A

Amitriptyline or SSRI

Narcotics (MS contin vs Fentanyl patch)

24
Q

What procedures are available for management of chronic pancreatitis?

A

Endoscopic: ductal dilation, stenting

Nerve blocks: celiac plexus (ethanol or steroids)

Lithotripsy

Resection (if CA suspected)

25
Q

Describe pancreatic carcinoma

A

4th leading cause of CA death in US

Dx late in disease

Majority are adenocarcinomas & located in the head of the pancreas

26
Q

What are RFs for pancreatic carcinoma?

A
Male
African American 
> 45 yo
Smoking, alcohol
Chronic pancreatitis
DM, obesity 
Fam hx
27
Q

What is the clinical presentation of pancreatic carcinoma?

A

Abd pain (gnawing epigastric, radiating to back)

Early satiety/anorexia

Wt loss

Painless jaundice

28
Q

What does pancreatic carcinoma look like on PE?

A
Cachectic 
Jaundice, icterus 
Left supraclavicular LNs 
Ascites
Palpable gall-bladder
29
Q

What labs can you use to dx pancreatic carcinoma?

A

Bilirubin & alkphos: elevated

Amylase/lipase: elevated

Mild anemia

Glucose intolerance

CA19-9

30
Q

What imaging can you use to dx pancreatic carcinoma?

A

U/S: dilated CBD

CT: TOC for staging

MRCP

ERCP: considered primary dx tool, “double duct sign”

EUS

31
Q

How do you treat pancreatic carcinoma?

A

Whipple