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GI 2 Final > Pancreatic Disorders - McGowan > Flashcards

Pancreatic Disorders - McGowan Flashcards

1
Q

what are the two most common cause of acute pancreatitis?

A
  1. Biliary tract gallstones
  2. Heavy alcohol use
    Others includes:
    - Hypertriglyceridemia
    - Trauma
    - Meds
    - ERCP
    - autoimmune (celiac disease, vasculitits)
    - Infection
    - dialysis
    - CP bypass
    - CFTR
    - Scorpion tring (tityus trinitatis)
    - Idiopathic
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2
Q

what 2 out of 3 things are needed to make a diagnosis of acute pancreatitis?

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

what lab findings are consistent with acute pancreatitis?

A
  • Increase lipase 3x ULN (more accurate)
  • Increaesd amylase 3x ULN
  • Hypocalcemia (due to saponification)
  • Whole bunch of other shit
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4
Q

what are some risk factors for acute pancreatitis?

A
  • smoking
  • high dietary glycemic load
  • abd adiposity
  • age and obesity
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5
Q

Severity of acute pancreatitis is based on which criteria?

A
  • Ranson criteria
  • Sequential organ failure assessment (SOFA)
  • Modified Marshall scoring system
  • APACHE II (>8 higher mortality)
  • Bedside index for severity in acute pancreatitis (BISAP)
  • presence of SIRS and elevated BUN on admission with a rise in BUN w/in 24 hrs of hospitalization
  • Revised atlanta classificaiton
  • CT grade of severity index of acute pancreatitis
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6
Q

On the Ranson criteria for acute pancreatitis, what are some predictors of severe course

A
  • age >55
  • WBC > 16k
  • glucose >200
  • LDH > 350
  • AST >250
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7
Q

In Ranson criteria for acute pancreatitis, developing of what within first 48 hrs indicates a worsening prognosis

A
  • HCT drop by 10%
  • BUN rise by > 5
  • arterial Po2 < 60
  • Ca <8
  • estimated fluid sequestration of > 6L
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8
Q

a score of what indicates 100% mortality according to Ranson criteria?

A

7-8

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9
Q

according to ATLANTA criteria for acute pancreatitis, what’s considered a moderate case?

A
  • transient organ failure <48 hrs and with or without local complications
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10
Q

On xray, sentinel loop represents what

A

segment of air-filled small intestine (most commonly in the LUQ)

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11
Q

On xray, colon cutoff sign represents what

A

gas filled segment of transverse colon abruptly ending at area of pancreatic inflammation
OR
focal linear atelectasis of the lower lobe of lung

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12
Q

CT with contrast should be avoided when Cr level is greater than

A

1.5

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13
Q

what imaging modality is best for specially focusing on an organ and it’s perfusion and look for areas of ischemia

A

Perfusion CT (PCT)

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14
Q

Perfusion CT looking for ischemia, and CT-guided need aspiration of necrotizing pancreatitis are done on which day after onset of acute pancreatitis?

A

Day 3

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15
Q

Which imaging modality is also therapeutic in that it can in draining a pancreatic pseudocyst?

A

Endoscopic ultrasound

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16
Q

Treatment for infected pancreatic necrosis with secondary gas formation (emphysematous pancreatitis)

A

Surgical debridement and Abx (imepenem or meropenem)

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17
Q

possible complication of severe acute pancreatitis (SAP)

A
  • intravascular volume depletion–> 3rd spacing; Ileus; pre-renal azotemia or ATN
  • Pleural effusion
  • Necrosis, wall-off necrosis (encapsulated)
  • Pseudocysts (encapsulated fluid collection with a high amylase content)
  • ARDS (within 3-7 days of onset)
  • Pancreatic ascites
18
Q

How is mild acute pancreatitis treated?

A
  • 80% resolves w/o complications
  • Pancreas rest (NPO, Bed rest, NG suction for ileus)
  • Fluid resuscitation (LOTS)
  • Pain control
  • resume oral intake once pain free and has bowel sounds
19
Q

what CT grade for acute pancreatitis indicates two or more acute peripancreatic fluid collection or retroperitoneal air?

A

Grade E: 4 points with > 50% necrosis, severity index of 10 with >17% mortality rate

20
Q

In which CT grade for acute pancreatitis are there no pancreatic necrosis

A

Grade A and B. Grade A is normal pancreas, Grade B is just an enlarged pancreas

21
Q

If pt presents with painless jaundice and pancreatic calcification on plain film and CT shows tumefactive chronic pancreatis, think

A

Pancreatic cancer

22
Q

Multiple episode of acute pancreatitis, PRSS1 defect of trypsinogen gene on chromosome 7 –> chronic pancreatitis, which enzyme would be deficient?

A

fecal elastase

23
Q

what are the etiologies of Chronic pancreatitis?

A

Mneumonic: TIGAR-O

  • Toxic-metabolic (alcoholic 45-80% of cases)
  • Idiopathic (early onset age 23 or late 62 yr)
  • Genetic (<30) (CFTR, PSTI, SPINK1, PRSS1)
  • Autoimmune (diagnosed via HISORt Crtieria); Hypergammaglobuinemia (IgG4)
  • Recurrent acute pancreatitis
  • Obstructive
24
Q

what labs are altered in chronic pancreatitis?

A
  • Acute attack: increased amylase and lipase
  • elevated alk phos and total bili
  • glycosuria
  • excess fecal fat
  • low B12
  • Genetic pancreatitis (low trypsinogen)
  • Autoimmune (elevated IgG4, ANA, ab to lactoferrin and carbonic anhydrase II
25
Q

list the types of pancreatic function tests

A
  • Trypsinogen (low level -> steatorrhea)
  • Fecal elastase (low in insufficiency)
  • Pancreatic malabsorption
  • Stimulation tests (CCK/secretin)
26
Q

what are you likely to see on plain xray in chronic pancreatitis?

A

Calcification (pancreaticolithiasis)

27
Q

What are you likely to see on CT of chronic pancreatitis?

A
  • may show calcification that wasn’t seen in xray
  • ductal dilation
  • tumefactive chronic pancreatitis = concern for pancreatic cancer
28
Q

what is the most sensitive imaging study for chronic pancreatitis?

A

ERCP, shows dilated ducts, intraductal stones, strictures, pseudocysts

29
Q

On endoscopic ultrasound what findings would indicate chronic autoimmune pancreatitis?

A
  • diffuse enlargement of pancreas, peripheral rim of hypoattenuation, irregular narrowing of main duct
30
Q

what complications are associated with chronic pancreatitis

A
  • brittle diabetes
  • pseudocyts or abscess
  • cholestatic liver enzymes
  • bile duct stricture
  • Pancreatic insufficiency
  • osteoporosis
  • peptic ulcer
  • pancreatic CA
31
Q

Pancreatic insufficiency due to exocrine glands malfunction can be confirmed by

A

response to therapy with pancreatic enzyme supplements

  • secretin stimulation, - detection of decreased fecal chymotrypsin
  • decreased pancreatic fecal elastase
  • B12 malabsorption
32
Q

Treatments for chronic pancreatitis

A
  • low fat diet
  • avoid alcohol
  • avoid opioids
  • pancreatic supplements for steatorrhea
  • H2 blocker, PPI, Na bicarb
  • CF pts: high dose pancreatic enzymes therapy
  • Treat DM
  • Autoimmune: corticosteroids
  • Endoscopic or surgical therapy (stent, dilation, lithtripsy, drainage)
33
Q

the main cause of death of chronic pancreatitis

A

pancreatic cancer

34
Q

Hypersecretion of insulin as seen in the pancreatic neuroendocrine tumor insulinoma is associated with which endocrine neoplasia?

A

MEN1

35
Q

nonbeta islet cell tumors associated with MEN1 and can lead to multiple peptic ulcers, and is commonly found in the duodenum

A

Gastrinoma

36
Q

which neoplasm are associated with MEN1

A
  • Pituitary adenoma
  • Parathyroid hyperplasia
  • Pancreatic tumors
37
Q

Which neoplasm are associated with MEN2A

A
  • parathyroid hyperplasia
  • medullary thyroid carcinoma
  • Pheochromocytoma
38
Q

Which neoplasm are associated with MEN2B

A
  • mucosal neuromas
  • marfanoid body habitis
  • Medullary thryoid carcinoma
  • Pheochromocytoma
39
Q

Pt has hypercalcemia, elevated PTH, acromegaly, or cushings.. which MEN type?

A

MEN1 : parathyroid –> hypercalcemia, elevated PTH; Pancreas –> gastrinoma aka ZE, insulinoma - hypoglycemia; Pituitary –> acromegaly, cushings

40
Q

Pt has elevated calcitonin and/or elevated catecholamines; and/or hypercalcemia, elevated PTH, which MEN type?

A

MEN 2A

41
Q

Pt with marfanoid body habitus, elevated calcitonin and/or elevated catecholamines, which men type

A

MEN 2B

GI 2 Final (11 decks)

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