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Clin med GI > pancreatic disorders > Flashcards

pancreatic disorders Flashcards

1
Q

What is the exocrine function of the pancreas

A

digestion
*secretes bicarb and digestive enzymes

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2
Q

What is the pancreas endocrine function

A

glucose homeostasis

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3
Q

What are the most common triggers of acute pancreatitis

A

gallstones and alcohol intake

*hypertriglyceridemia and ACEi are also common

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4
Q

What helps diagnosis of acute pancreatitis

A

serum amylase and Lipase
clinical presentation
imaging

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5
Q

What is the treatment for actor pancreatitis

A

IV fluids
analgesics
nutritional support

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6
Q

What toxins can cause acute pancreatitis

A

scorpion bites
organophosphate poisoning

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7
Q

What level of alcohol intake can lead to acute pancreatitis

A

> 4-7 drinks/day in men
3drinks/day in women

**generally from binge drinking rather than chronic

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8
Q

What is the patient presentation with acute pancreatitis

A

severe, upper abdominal pain with radiation (boring) to back with frequent N/V

diaphoretic and ill appearing

semi- comatose

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9
Q

What is grey turner sign and what is it associated with

A

ecchymoses of the flanks

acute pancreatitis

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10
Q

What is Cullen sign and what is it associated with

A

ecchymosis of the umbilical region

acute pancreatitis

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11
Q

What may help reduce some pain with acute pancreatitis

A

Sitting up ad leaning forward

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12
Q

What is the presentation difference between gallstone and alcohol pancreatitis

A

Gallstone occurs suddenly

alcohol occurs over a few days

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13
Q

What is the top differential dx is acute pancreatitis

A

perforated gastric/duodenal ulcer

*also r/o inferior wall MI

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14
Q

When is genetic testing recommended with acute pancreatitis

A

if <30y/o

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15
Q

When should a pancreatic tumor be highly considered with acute pancreatitis

A

> 40y/o

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16
Q

When should TG be considered as the cause of acute pancreatitis

A

> 1000mg/dl

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17
Q

What is the dx criteria for acute pancreatitis

A

Abdominal pain consistent with acute pancreatitis

serum lipase >3x upper limit of normal

Findings consistent on imagining

*need 2 of the 3

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18
Q

What lab work gives the best evaluation of acute pancreatitis

A

Rising BUN or rising Hct

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19
Q

What lab is most specific for pancreatitis

A

Lipase

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20
Q

How long do labs stay elevated with acute pancreatitis

A

Increase the first day and return to normal in 3-7 days

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21
Q

When may labs remain normal with acute pancreatitis

A

Destruction of acinar tissue in previous episodes

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22
Q

When may labs remain normal

A
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23
Q

If there is an elevated anion gap with acute pancreatitis, what is it indicative of

A

metabolic acidosis & shock

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24
Q

What is the imaging study of choice with pancreatitis

A

CTA

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25
Q

what risk factors predict a severe course of acute pancreatitis

A

systemic inflammatory response syndrome (SIRS)

AMS

comorbid health problems

BMI > 30

hypovolemia markers

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26
Q

What is the Ranson criteria

A

cumbersome, takes 48 hours
could negative predictive value of acute pancreatitis

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27
Q

What is the APACHE II score

A

good negative predictive value of acute pancreatitis
*complex & cumbersome

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28
Q

What is BISAP and what is it used for

A

Bedside index of severity in acute pancreatitis

calculated during first 24 hours

good positive predictor value of severe case M&M

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29
Q

What is the Balthazar score

A

CT severity index score based on the degree of necrosis and fluid presence for acute pancreatitis

30
Q

What are the types of acute pancreatitis

A

Interstitial
Necrotizing

31
Q

What is mild acute pancreatitis

A

Inflammation confined to pancreas and close vicinity, no organ failure or systemic/local complications

32
Q

What is mild acute pancreatitis

A

Local or systemic complications but no organ failure

33
Q

What is severe acute pancreatitis

A

Peristent single or multi organ failure and 1 or more local complications

34
Q

When is the most important stage in management of acute pancreatitis

A

in the first 12-24 hours

-fluid resuscitation
-analgesia
- nutritional support

35
Q

What is the foundation of acute pancreatitis management

A

early & aggressive fluid resuscitation

*monitor BUN, Hct, and urine output Q4-6 hours in first 24 hours to adjust fluid rate

36
Q

What is included in lactated ringers

A

Sodium, chloride, lactate, potassium, calcium

37
Q

If there is no response to immediate management of acute pancreatitis, what is it indicative of

A

high likelihood of MODS/SIRS

38
Q

How long does someone with acute pancreatitis need to stay NPO

A

until abdominal pain, n/v, appetite, ileum improve/resolve

39
Q

If a patients acute pancreatitis is from gallstones, how do you manage their treatment

A

Cholecystectomy

40
Q

If a patients acute pancreatitis is from cholangitis/billiary obstruction, how do you manage their treatment

A

ERCP w/n 24 hours of presentation

41
Q

If a patients acute pancreatitis is from hypertriglyceridemia, how do you manage their treatment

A

bring down and maintain <500mg/dl

*apheresis and insulin drip +/- glucose

42
Q

What is a pancreatic pseudocyst

A

Pancreatic and peri pancreatic collections of enzyme rich fluid +/- necrotic material

*most resolve spontaneously

43
Q

What will be seen on imaging with acute pancreatic necrosis

A

gas bubbles on imaging/CT-guided percutaneous aspiration

44
Q

When is surgery done for acute pancreatitis

A

if the organ has deteriorated despite abx

45
Q

What criteria makes the dx for SIRS

A

Temp >38.3 or <36
HR >90bpm
RR>20
WBC> 12,000 or <4000

46
Q

What are the 2 major risk factors for chronic pancreatitis

A

alcohol and smoking

47
Q

What is the predominant symptoms of chronic pancreatitis

A

abdominal pain

48
Q

What is the treatment for chronic pancreatitis

A

pain control and mngmt of pancreatic insufficiency

49
Q

What is chronic pancreatitis

A

Persistent inflammation due to permanent structural damage

50
Q

What is the hallmark of chronic pancreatitis

A

Fibrosis caused by inflammation and recurrent pancreatic injury

51
Q

What are the primary manifestations of chronic pancreatitis

A

abdominal pain and pancreatic insufficiency

52
Q

What is steatorrhea

A

high fat stool

53
Q

What are signs of pancreatic insufficiency

A

flatulence
abdominal distention
steatorrhea
undernutrition
weight loss
fatigue

54
Q

What is needed for diagnosis of chronic pancreatitis

A

Clinical assessment
imaging
pancreatic function tests

55
Q

How may chronic pancreatitis look on KUB

A

Calcified

56
Q

How may chronic pancreatitis appear on US

A

Atrophy with dilated main pancreatic duct with intraductsal calculi

57
Q

What imaging modality is frequently used for chronic pancreatitis diagnosis

A

MRI

58
Q

What type of pancreatic function tests are there

A

Direct (enzyme secretion)

Indirect (fat malabsorption)

59
Q

When is direct pancreatic function tests Most useful

A

in earlier stages when imaging isn’t diagnostic

60
Q

What is administered for diet pancreatic function test

A

IV CCK and then IV secretin for bicarb production

61
Q

How do you treat chronic pancreatitis

A

Smoking/ETOH cessation
pain control
pancreatic enzyme supplements

62
Q

What is used for indirect pancreatic function tests

A

Serum Trypsinogen
Steatorrhea

63
Q

How do you give pancreatic enzyme replacement

A

25k - 50k IU lipase per meal and half dose with snacks along with PPI/H2 blocker to prevent enzyme breakdown

64
Q

Who may present with unopposed and prolonged hypoglycemia

A

pancreatogenic diabetes

65
Q

What is exocrine pancreatic insufficiency (EPI)

A

Reduction in pancreatic enzyme activity
*mainly lipase

66
Q

What are the 2 primary causes of EPI

A

chronic pancreatitis in adults
CF in children

67
Q

How much pancreatic function is typically lost before EPI occurs

A

> 90%

68
Q

How do you treat / manage EPI

A

Monitor body weight / BMI
Screen for nutritional deficiency
referral to dietician
address any causes

69
Q

What is the mainstay treatment of exocrine pancreatic function

A

pancreatic enzyme replacement therapy (PERT)

70
Q

What type of malabsorption happens first in EPI

A

Fat before carb/protein

Clin med GI (9 decks)

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