Pancreatic Disorders Flashcards
In a patient with ARDS, what will the chest Xray look like?
- bilateral diffuse fluffy infiltrates
- normal cardiac size
- Tracheostomy tub
- Left subclavian central line going insdie the right atrium
- ECG wires
Definition of Acute pancreatitis
Cellular injury from:
- activation of protein kinases
- inflammatory mediator
- activation of digestive enzymes in pancreas
- trypsinogen to trypsin results in autodigestion of pancreas and peri-pancreatic tissues
What 2 things were at the top of the Etiology list for pancreatitis?
- gallstones <5mm
- Heavy alcohol use
What is needed to make the diagnosis of acute pancreatitis?
At least 2 of the 3 things:
- Epigastric pain
- Lipase (and amylase) 3x the ULN
- CT changes consistent with pancreatitis
What was the one bolded lab finding for acute pancreatitis?
increased lipase 3x ULN
What is the thing with soap that happens during acute pancreatitis?
Saponification
-interaction of cations with FFAs released by the action of activated lipase on TGs in fat cells —> low blood calcium
What’s the deal with Amylase? Why are we more concerned with lipase than amylase?
- Amylase may be elevated in other conditions
- Lipase is just more specific it looks like
Risk factors for acute pancreatitis?
- smoking
- high dietary glycemic load
- abdominal adiposity
- high age and obesity: increases changes of more severe course
Protective factors against acute pancreatitis?
- veggies
- maybe the use of statins
What do we do to assess the severity of Pancreatitis?
- Ranson criteria
- APACHE II (>8= higher mortality)
- greater the rise in BUN the greater the mortality
- REvised Atlanta classification
- CT Grade of severity index
What is the Ranson criteria for assessing the severity of acute pancreatitis?
3 or more or the following means severe course:
- age >55
- WBC>16
- Blood glucose >200mg
- LDH >350
- AST >250
If these things happen, it just gets worse
- HCT drop or more than 10%
- BUN rise of >5
- PO2 of <60
- Serum Ca<8
- Base deficit over 4
- estimated fluid sequestration of > 6L
What’s the relationship between the number of Ranson criteria present and the mortality rate?
0-2 means mortality rate of 1%
3-4 is 16%
5-6 is 40%
7-8 is 100%
What is the goofy pneumonic that she gave us for the ranson criteria?
GA-LAW (at admission)
C and HOBBS (48 hrs after admission)
-bring this up if can’t remember, slide 26 of pancreas lecture
What is the revised ATLANTA criteria?
- Mild: no organ failure, no local complications
- Moderate: transient organ failure <48 hrs, local complications
- Severe: persistent organ failure >48 hrs
What is Cullen’s sign?
ecchymosis of umbilicus from retroperitoneum fluid and bleeding
Grey turner sign
Ecchymosis of flank from fluid and blood in the retroperitoneum
Imaging of acute pancreatitis
- sentinel loop
- colon cutoff sign
- rapid-bolud IV contrast enhanced CT
- perfusion CT to figure out if an organ is failing or not
Emphysematous pancreatitis
when there’s infected pancreatic necrosis with secondary gas formation
-from gas forming organisms: C perf, enterobacter aerogenes, enterococcus faecalis
Tx of emphysematous pancreatitis
surgical debridement and abx
What are some complications of severe acute pancreatitis?
Intravascualr volume depletion
- walled-off necrosis
- Pseudocysts (high amylase content)
- ARDS
- Pancreatic ascites
How do you treat SAP (severe acute pancreatitis)?
just treat the cause
- alcoholic: abstinence…
- Gallstone: timely lap choecystectomy
- etc…
Tx. of mild acute pancreatitis?
80% resolve sponateously
Tx of severe actue pancreatitis
within 48 hours of admission, start enteral feedings with nasogastric or nasojejunal tube- reduces risk of multiorgan failure and mortality
Etiology
TIGAR-O
- Toxic Metabolic (alcoholic)
- Idiopathic
- Genetic (CFTR, PSTI, SPINK1, PRSS1)
- Autoimmune (IgG4)
- Recurrent
- Obstructive
