Pancreatic Disorders Flashcards
What are the 2 most common causes of acute pancreatitis?
ETOH and gallstones
What are additional causes of acute pancreatitis?
- meds
- iatrogenic (ERCP)
- malignancy
- scorpion bite
- Mumps in children
- Trauma
What condition can cause acute pancreatitis in children?
Mumps
What is the pathophysiology of acute pancreatitis?
Acinar cell injury –> intracellular activation of enzymes –> auto-digestion of pancreas
What are the clinical manifestations of acute pancreatitis?
- epigastric abdominal pain
- radiates to back
- relieved with leaning forward, sitting, fetal position
- N/V
- Fever
What is often found on PE in patients with acute pancreatitis?
- epigastric tenderness
- decreased bowel sounds
- +/- exudative pleural effusion
- Cullen’s/Grey Turner’s sign (uncommon signs of necrotizing pancreatitis)
What is Cullen’s sign?
periumbilical ecchymosis sometimes seen with necrotizing (hemorrhagic) pancreatitis
What is Grey Turner’s sign?
flank ecchymosis sometimes seen with necrotizing (hemorrhagic) pancreatitis
What is the diagnostic test of choice for acute pancreatitis?
Abdominal CT
What is the most specific diagnostic test for acute pancreatitis?
Lipase (increases in 7-14 days)
Which laboratory tests are suggestive of acute pancreatitis?
- Lipase
- Amylase (>3x ULN)
- ALT (increased 3 fold highly suggestive of gallstone pancreatitis)
- Hypocalcemia
- Hypertriglyceridemia
- Increased glucose
Why are patients hypocalcemic in acute pancreatitis?
the digested fat binds to the calcium lowering serum calcium levels
Pancreatic calcification is suggestive of what?
chronic pancreatitis
What is the management of acute pancreatitis?
NPO
IVFs
Analgesics
DO NOT use antibiotics prophylactically!
When is an ERCP indicated in acute pancreatitis?
if biliary sepsis is suspected
is only effective in obstructive jaundice
Why is morphine not generally used for patients with acute pancreatitis and what analgesic is generally used?
is associated with increased spasm of Sphincter of Odi
Meperidine (Demerol)
What is colon cutoff sign and when is it seen?
abrupt collapse of colon near the pancreas
sometimes seen with acute pancreatitis
What can be seen on abdominal x-ray with acute pancreatitis?
+/- sentinel loop = localized ileus
dilated small bowel in LUQ
colon cutoff sign
What is the Ranson criteria based on upon admission?
Glucose Age LDH AST WBC
What is the Ranson criteria based on within 48 hours of admission?
Calcium Hematocrit Oxygen BUN Base deficit
What are the most common causes of chronic pancreatitis?
- ETOH abuse (MC)
- Idiopathic
- Hypocalcemia
- Hyperlipidemia
- Cystic fibrosis in children
What is the most common cause of pancreatic exocrine insufficiency/chronic pancreatitis in children?
cystic fibrosis
What is the classic triad that is diagnostic for chronic pancreatitis?
- calcifications
- steatorrhea
- diabetes mellitus
What is the diagnostic test of choice for chronic pancreatitis and what will it show?
Abdominal x-ray showing a calcified pancreas
Are amylase and lipase usually elevated with chronic pancreatitis?
NO!
What is the management of chronic pancreatitis?
oral pancreatic enzyme replacement
ETOH abstinence
pain control
What is the pathophysiology of chronic pancreatitis?
chronic inflammation causing parenchymal destruction, fibrosis and calcification resulting in loss of exocrine and sometimes endocrine function
