pancreatic disorder

Question 1

acute inflammatory process that may involve surrounding tissue and organs w/ 5% overall mortality & 20% will have necrosis

Answer 1

acute pancreatitis

Question 2

two most common causes of acute pancreatitis

Answer 2

alcohol and gallstones

Question 3

after sentineal case of acute case, loss of endocrine & exocrine function
irreversible progressive fibrosis & calcification

Answer 3

chronic pancreatitis

Question 4

what is this condition?

• severe, acute upper abd. pain w/ possible radiation
• better w/ sitting up or bending forward
• N/V

if they have severe case what symptom will you likely see?

Answer 4

acute pancreatitis
dyspnea can happen w/ severe pancreatitis

Question 5

describe difference in pain presentation when acute pancreatitis is d/t gallstones vs other causes (2)

Answer 5

if d/t gallstones, pain is rapid- peaks w/in 10-20mins and well localized
if d/t other causes, it’d be poorly localized, less abrupt onset

Question 6

condition when you have 2 smaller pancreatic ducts instead of 1 big one. since they are smaller, they are more likely to get things stuck in them

Answer 6

pancreas divisum (an obstructive cause of acute pancreatitis)

Question 7

4 obstructive causes of acute pancreatitis

Answer 7

gallstones
pancreas divisum
tumors
post ERCP

Question 8

2 toxic causes of acute pancreatitis

Answer 8

alcohol
meds– aminosalicylates, flagyl, sulfa, pentamidine, azathioprine

Question 9

BADSHIT is acronym for etiologies of acute pancreatitis. What does it stand up?

Answer 9

• Biliary
• Alcohol
• Drugs– lasix, antiHIV, HCTz
• Surgery
• Hereditary, Hyperlipid states
• Iatrogenic (post ERCP), idiopathic, infection
• Tumor, trauma, trinidad scorpion bite

Question 10

how does smoking affect pancreas? (2)

Answer 10

increases risk of both types of pancreatitis
increases risk of pancreas adenocarcinoma

Question 11

what do you need to diagnose pancreatitis?

Answer 11

clinical picture + amylase/lipase levels OR US/CT

Question 12

of all the labs you can get to work up pancreatitis, which one looks for necrotic/dead tissue?

Answer 12

lactate

Question 13

between amylase & lipase, which stays elevated for longer & is more sensitive?

Answer 13

lipase

Question 14

amylase can be WNL in what two scenarios?

Answer 14

hypertrig. & alcoholics

Question 15

relationship btwn amylase/lipase levels & severity of dz

Answer 15

does NOT correlate

Question 16

differentiate mild v. moderate v. severe acute pancreatitis

Answer 16

• mild: no organ failure or complications
• moderate: transient (under 48hrs) organ compromise, local complication
• severe: persistent (over 48hrs) organ failure

majority are mild

Question 17

general tx of acute pancreatitis (4)

Answer 17

IV lactated ringers 250-400 cc/hr (careful in HF or dialysis)
enteral feeding/NPO
ERCP or cholecystectomy
pain management

Question 18

which treatment does this

decreased infectious complicatins
decreased hospital stay & mortality
less organ failure

Answer 18

enteral feeding

Question 19

if they have a gallstone or tumor & a stent is needed, what tx can you do?

Answer 19

ERCP or cholecystectomy

Question 20

2 labs to monitor during IV fluids inorder to adjust it?

Answer 20

hematocrit– falls with RE-hydration
BUN– if too high, its sign that kidney is starting to fail

first 48 hrs very important

Question 21

on admission (up to 5 points)
- over 55 yo
- leukocyte over 16K
- glucose over 200
- LDH over 350
- AST over 250

first 48 hrs
- HCT over 10%
- BUN over 5
- Ca++ under 8
- PaO2 under 60
- Base deficit over 4
- fluid sequestration over 6

Answer 21

Ranson’s criteria for acute pancreatitis

Question 22

4 things that make up lactated ringer fluid

Answer 22

NaCl
Na Lactate
K+
Ca++

Question 23

list two types of complications of acute pancreatitis

Answer 23

• hemorrhagic: cullens (dark umbilical region), gray turners (bruised flanks)
• pseudocyst from liquid getting stuck: N/V, ileus

Question 24

• constant upper abdominal pain, worse w/ food; episodic or steady
• malabsortion– wt loss, steatorrhea, vitamin deficiency
• diabetes

Answer 24

sx of chronic pancreatitis

Question 25

biggest cause of chronic pancreatitis

Answer 25

alcohol– affects aciner cells & leads to less lithostatin production

Question 26

4 parts of diagnosing chronic pancreatitis

Answer 26

clin fx + changes in pancreas
normal amylase & lipase
histology is gold standard
imaging

Question 27

most sensitive imaging for chronic pancreatitis

Answer 27

ERCP– can see abnormal main & side branches, stricture, dilation, stones

Question 28

4 general parts of managing chronic pancreatitis

Answer 28

• stop smoking & drinking; eat low fat
• manage pain
• manage complication
• correct pancreatic insufficiency– enzyme replacement, vitamins, medium chain trig.

Question 29

5 comlications of chronic pancreatitis

Answer 29

• pseudocyst
• bile duct obstruction
• splenic vein thrombosis
• pseudoaneurysms
• pancreatic cancer

Question 30

where is most pancreatic adenocarcinoma located?

Answer 30

head of pancreas

Question 31

nonspecific, poorly localizeed epigastric or back pain
painless jaundice, chronic pancreatitis-like symptoms

Answer 31

pancreatic cancer sx

Question 32

4 risk factors for pancreatic cancer

Answer 32

• smoking
• genetics
• chronic pancreatitis
• over 50 yo

Question 33

4 imaging options for pancreatic cancer & 3 treatment options

Answer 33

• imaging: US, CT, ERCP, EUS
• tx: staging, surgery, palliative care