Pancreatic Disorders Flashcards

1
Q

What are the 2 most common causes of acute pancreatitis?

A

ETOH and gallstones

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2
Q

What are additional causes of acute pancreatitis?

A
  1. meds
  2. iatrogenic (ERCP)
  3. malignancy
  4. scorpion bite
  5. Mumps in children
  6. Trauma
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3
Q

What condition can cause acute pancreatitis in children?

A

Mumps

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4
Q

What is the pathophysiology of acute pancreatitis?

A

Acinar cell injury –> intracellular activation of enzymes –> auto-digestion of pancreas

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5
Q

What are the clinical manifestations of acute pancreatitis?

A
  1. epigastric abdominal pain
  2. radiates to back
  3. relieved with leaning forward, sitting, fetal position
  4. N/V
  5. Fever
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6
Q

What is often found on PE in patients with acute pancreatitis?

A
  1. epigastric tenderness
  2. decreased bowel sounds
  3. +/- exudative pleural effusion
  4. Cullen’s/Grey Turner’s sign (uncommon signs of necrotizing pancreatitis)
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7
Q

What is Cullen’s sign?

A

periumbilical ecchymosis sometimes seen with necrotizing (hemorrhagic) pancreatitis

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8
Q

What is Grey Turner’s sign?

A

flank ecchymosis sometimes seen with necrotizing (hemorrhagic) pancreatitis

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9
Q

What is the diagnostic test of choice for acute pancreatitis?

A

Abdominal CT

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10
Q

What is the most specific diagnostic test for acute pancreatitis?

A

Lipase (increases in 7-14 days)

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11
Q

Which laboratory tests are suggestive of acute pancreatitis?

A
  1. Lipase
  2. Amylase (>3x ULN)
  3. ALT (increased 3 fold highly suggestive of gallstone pancreatitis)
  4. Hypocalcemia
  5. Hypertriglyceridemia
  6. Increased glucose
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12
Q

Why are patients hypocalcemic in acute pancreatitis?

A

the digested fat binds to the calcium lowering serum calcium levels

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13
Q

Pancreatic calcification is suggestive of what?

A

chronic pancreatitis

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14
Q

What is the management of acute pancreatitis?

A

NPO
IVFs
Analgesics

DO NOT use antibiotics prophylactically!

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15
Q

When is an ERCP indicated in acute pancreatitis?

A

if biliary sepsis is suspected

is only effective in obstructive jaundice

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16
Q

Why is morphine not generally used for patients with acute pancreatitis and what analgesic is generally used?

A

is associated with increased spasm of Sphincter of Odi

Meperidine (Demerol)

17
Q

What is colon cutoff sign and when is it seen?

A

abrupt collapse of colon near the pancreas

sometimes seen with acute pancreatitis

18
Q

What can be seen on abdominal x-ray with acute pancreatitis?

A

+/- sentinel loop = localized ileus
dilated small bowel in LUQ
colon cutoff sign

19
Q

What is the Ranson criteria based on upon admission?

A
Glucose
Age
LDH
AST
WBC
20
Q

What is the Ranson criteria based on within 48 hours of admission?

A
Calcium
Hematocrit
Oxygen
BUN
Base deficit
21
Q

What are the most common causes of chronic pancreatitis?

A
  1. ETOH abuse (MC)
  2. Idiopathic
  3. Hypocalcemia
  4. Hyperlipidemia
  5. Cystic fibrosis in children
22
Q

What is the most common cause of pancreatic exocrine insufficiency/chronic pancreatitis in children?

A

cystic fibrosis

23
Q

What is the classic triad that is diagnostic for chronic pancreatitis?

A
  1. calcifications
  2. steatorrhea
  3. diabetes mellitus
24
Q

What is the diagnostic test of choice for chronic pancreatitis and what will it show?

A

Abdominal x-ray showing a calcified pancreas

25
Are amylase and lipase usually elevated with chronic pancreatitis?
NO!
26
What is the management of chronic pancreatitis?
oral pancreatic enzyme replacement ETOH abstinence pain control
27
What is the pathophysiology of chronic pancreatitis?
chronic inflammation causing parenchymal destruction, fibrosis and calcification resulting in loss of exocrine and sometimes endocrine function