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GI Final > Pancreatic Disorders > Flashcards

Pancreatic Disorders Flashcards

1
Q

In a patient with ARDS, what will the chest Xray look like?

A
  • bilateral diffuse fluffy infiltrates
  • normal cardiac size
  • Tracheostomy tub
  • Left subclavian central line going insdie the right atrium
  • ECG wires
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2
Q

Definition of Acute pancreatitis

A

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
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3
Q

What 2 things were at the top of the Etiology list for pancreatitis?

A
  • gallstones <5mm

- Heavy alcohol use

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4
Q

What is needed to make the diagnosis of acute pancreatitis?

A

At least 2 of the 3 things:

  • Epigastric pain
  • Lipase (and amylase) 3x the ULN
  • CT changes consistent with pancreatitis
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5
Q

What was the one bolded lab finding for acute pancreatitis?

A

increased lipase 3x ULN

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6
Q

What is the thing with soap that happens during acute pancreatitis?

A

Saponification

-interaction of cations with FFAs released by the action of activated lipase on TGs in fat cells —> low blood calcium

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7
Q

What’s the deal with Amylase? Why are we more concerned with lipase than amylase?

A
  • Amylase may be elevated in other conditions

- Lipase is just more specific it looks like

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8
Q

Risk factors for acute pancreatitis?

A
  • smoking
  • high dietary glycemic load
  • abdominal adiposity
  • high age and obesity: increases changes of more severe course
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9
Q

Protective factors against acute pancreatitis?

A
  • veggies

- maybe the use of statins

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10
Q

What do we do to assess the severity of Pancreatitis?

A
  • Ranson criteria
  • APACHE II (>8= higher mortality)
  • greater the rise in BUN the greater the mortality
  • REvised Atlanta classification
  • CT Grade of severity index
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11
Q

What is the Ranson criteria for assessing the severity of acute pancreatitis?

A

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
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12
Q

What’s the relationship between the number of Ranson criteria present and the mortality rate?

A

0-2 means mortality rate of 1%
3-4 is 16%
5-6 is 40%
7-8 is 100%

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13
Q

What is the goofy pneumonic that she gave us for the ranson criteria?

A

GA-LAW (at admission)
C and HOBBS (48 hrs after admission)
-bring this up if can’t remember, slide 26 of pancreas lecture

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14
Q

What is the revised ATLANTA criteria?

A
  • Mild: no organ failure, no local complications
  • Moderate: transient organ failure <48 hrs, local complications
  • Severe: persistent organ failure >48 hrs
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15
Q

What is Cullen’s sign?

A

ecchymosis of umbilicus from retroperitoneum fluid and bleeding

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16
Q

Grey turner sign

A

Ecchymosis of flank from fluid and blood in the retroperitoneum

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17
Q

Imaging of acute pancreatitis

A
  • sentinel loop
  • colon cutoff sign
  • rapid-bolud IV contrast enhanced CT
  • perfusion CT to figure out if an organ is failing or not
18
Q

Emphysematous pancreatitis

A

when there’s infected pancreatic necrosis with secondary gas formation
-from gas forming organisms: C perf, enterobacter aerogenes, enterococcus faecalis

19
Q

Tx of emphysematous pancreatitis

A

surgical debridement and abx

20
Q

What are some complications of severe acute pancreatitis?

A

Intravascualr volume depletion

  • walled-off necrosis
  • Pseudocysts (high amylase content)
  • ARDS
  • Pancreatic ascites
21
Q

How do you treat SAP (severe acute pancreatitis)?

A

just treat the cause

  • alcoholic: abstinence…
  • Gallstone: timely lap choecystectomy
  • etc…
22
Q

Tx. of mild acute pancreatitis?

A

80% resolve sponateously

23
Q

Tx of severe actue pancreatitis

A

within 48 hours of admission, start enteral feedings with nasogastric or nasojejunal tube- reduces risk of multiorgan failure and mortality

24
Q

Etiology

A

TIGAR-O

  • Toxic Metabolic (alcoholic)
  • Idiopathic
  • Genetic (CFTR, PSTI, SPINK1, PRSS1)
  • Autoimmune (IgG4)
  • Recurrent
  • Obstructive
25
Q

What is SAPE?

A

Sentinel acute pancreatitis event

  • hypothesis of pathogenesis of chronic panreatitis
  • there’s an initial (sentinel) acute pancreatitis event that initiates an inflammatory process that results in injury and later fibrosis (“necrosis-fibrosis”)
26
Q

What are some pancreatic funciton tests?

A
  • Trypsinogen: level is low in insuficiency…. causes steatorrhea
  • Fecal elastase: low in insufficiency
  • stimulation tests: cholecystokinin/secretin
27
Q

What will imaging show for chronic pancreatitis?

A

Calcifications

-tumefactive chronic pancreatitis= concern for pancreatic Cancer

28
Q

What will EUS look like for chronic pancreatitis?

A

Autoimmune= diffuse enlargement of the pancreas, a peripheral rim of hypoattenuation, and irregular narrowing of the main PD

29
Q

What does the exocrine pancreas secrete?

A

Amylase
protease
lipase

30
Q

What does the endocrine pancreas secrete

A

insulin
somatostatin
glucagon

31
Q

How is exocrine pancreatic insufficiency confirmed?

A

-by response to therapy with pancreatic enzyme supplements

32
Q

What do most people with endocrine insufficiency develop?

A

Diabetes mellitus

33
Q

What is absolutely forbidden in chronic pancreatitis?

A

alcohol

34
Q

What is the main cause of death in chronic pancreatitis?

A

Pancreatic Cancer

-prognosis is better in patients with etiology from a remediable condition or autoimmune hepatitis

35
Q

Which MEN syndrome is associated with hypoglycemia

A

MEN1

-there’s a hypersecretion of insulin

36
Q

Where is a Gastrinoma most commonly found?

A

duodenum

-2nd most common spot is the pancreas

37
Q

What does MEN1 have?

A

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumors

38
Q

what does MEN2A?

A

Parathyroid hyperplasia
medullary thyroid carcinoma
Pheochromocytoma

39
Q

What does MEN2B have?

A

Mucosal neuromas
Marfanoid body habitus
Medullary thyroid carcinoma
Pheochromocytoma

40
Q

How do you dx MEN Type 1?

A

2 or more of the following:

  • Parathyroid: hypercalcemia, high intact PTH
  • Pancreas: Gastinoma (ZE), Insulinoma- hypoglycemia
  • Pituitary: cushing syndrome
41
Q

MEN 2A

A

2 or three of the following:

  • Thyroid (Medullary Thyroid Ca): elevated calcitonin
  • Adrenal (Pheochromocytoma): elevated catcholamines
  • Parathyroid: Hypercalcemia, high intact PTH
  • 2-5% percent will develop Hirschsprung disease
42
Q

MEN2B

A
  • Marfanoid body habitus
  • Medullary thyroid cancer: elevated calcitonin
  • Pheochromocytomas: elevated catecholamines
  • Neuromas: occur on lips, tongue, mouth, eyelids, etx.
  • Frequently a new gene mutation: no family history

GI Final (13 decks)

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