Pancreatic Patient Flashcards
Is Acute Pancreatitis an emergency?
YES
What occurs with Acute Pancreatitis?
Activation of digestive enzymes = autodigestion
What are common causes of Acute Pancreatitis?
Gallstones
Heavy alcohol use
Hypertriglyceridemia
Trauma, meds
Symptoms of Acute Pancreatitis?
Epigastric/RUQ pain that radiates straight through to the back
Where does the pain radiate with Acute Pancreatitis?
Straight through to the back
What may be seen on the skin with Acute Pancreatitis?
Cullen sign = belly bruise
Grey Turner Sign = flank bruise
Abdominal exam findings with Acute Pancreatitis?
Abdominal tenderness with decreased bowel sounds
What may be found with a lung exam with Acute Pancreatitis?
Possible difficulty breathing with crackles due to pleural effusions
What ion will be decreased with Acute Pancreatitis and what are the corresponding (+) findings?
HYPOcalcemia
= Chvostek sign and Trousseau sign (+)
Chvostek - facial nerve spasm
Trousseau - bp cuff causes carpal spasm
What are the diagnostic criteria for Acute Pancreatitis?
2/3 of the following:
- Epigastric pain
- CT changes consistent with pancreatitis
- Lipase (and amylase) 3X the upper limit of normal
What are the diagnostic criteria for Acute Pancreatitis?
2/3 of the following:
- Epigastric pain
- CT changes consistent with pancreatitis
- Lipase (and amylase) 3X the upper limit of normal
Difference between Lipase and Amylase?
Amylase can be increased in other conditions
= LIPASE IS MORE ACCURATE
Difference between Lipase and Amylase?
Amylase can be increased in other conditions
= LIPASE IS MORE ACCURATE
A CT with or without contrast can be obtained for Acute Pancreatitis. When should you avoid using contrast?
Cr > 1.5
What are 2 things that may be seen on X-ray with Acute Pancreatitis?
Sentinel Loop
Colon Cutoff Sign
What are 2 things that may be seen on X-ray with Acute Pancreatiits?
Sentinel Loop
Colon Cutoff Sign
Sentinel loop
Segment of air-filled small intestine in LUQ
- Sign of Acute Pancreatitis
Colon Cutoff Sign
Gas-filled segment of transverse colon that ABRUPTLY ends at area of Pancreatic inflammation
What are possible complications of Acute Pancreatitis?
- Intravascular volume depletion
- Necrosis with possible infection
- Acute Respiratory Distress Syndrome, Pleural Effusion
- Ileus with fluid-filled loop
- Pseudocysts, pancreatic ascites, chronic pancreatitis
What are possible complications of Acute Pancreatitis?
- Intravascular volume depletion
- Necrosis with possible infection
- Acute Respiratory Distress Syndrome, Pleural Effusion
- Ileus with fluid-filled loop
- Pseudocysts, pancreatic ascites, chronic pancreatitis
First treatment for Acute Pancreatitis?
IV FLUID RESUSCITATION
First treatment for Acute Pancreatitis and what is may worsen?
IV FLUID RESUSCITATION
- may worsen pain and acute respiratory distress syndrome
If severe acute pancreatitis, what should be given for treatment?
- IV Calcium Gluconate for hypocalcemia
- fresh frozen plasma and albumin
- enteral feedings
What are 4 severity indicators for Acute Pancreatitis?
- GA-LAW
- C and HOBBS
- APACHE II > 8 = higher mortality
- BISAP score (0-5)
What is Chronic Pancreatitis?
Irreversible damage to pancreas
- necrosis -> fibrosis
Causes of Chronic Pancreatitis?
TIGAR-O
- Toxic-metabolic – usually alcohol
- Idiopathic – smoking is risk factor
- Genetic
- Autoimmune – celiac/IgG4
- Recurrent acute pancreatitis
- Obstruction
Causes of Chronic Pancreatitis?
TIGAR-O
- Toxic-metabolic – usually alcohol
- Idiopathic – smoking is risk factor
- Genetic
- Autoimmune – celiac/IgG4
- Recurrent acute pancreatitis
- Obstruction
Symptoms of Chronic Pancreatitis?
Chronic/intermittent epigastric pain
Pancreatic insufficiency
Symptoms of Chronic Pancreatitis?
Chronic/intermittent epigastric pain
Pancreatic insufficiency
Chronic pancreatitis often has pancreatic insufficiency. What are the signs of exocrine and endocrine insufficiency?
Exocrine = steatorrhea Endocrine = diabetes mellitus
Chronic Pancreatitis often has pancreatic insufficiency. What are the signs of exocrine and endocrine insufficiency?
Exocrine = steatorrhea Endocrine = diabetes mellitus
Fecal changes that are reflective of pancreatic insufficiency with Chronic Pancreatitis?
Fecal fat INCREASED
Fecal chymotrypsin and elastase DECREASED
What will be seen on imaging with Chronic Pancreatitis?
CALCIFICATIONS
What will be seen on imaging with Chronic Pancreatitis?
CALCIFICATIONS
Possible complications of Chronic Pancreatitis?
Pancreatic cancer
Pancreatic insufficiency – diabetes
Pancreatic cancer is usually what type?
Adenocarcinoma
Where are tumors usually located with pancreatic cancer and the resulting signs?
Pancreatic head
-> biliary obstruction -> jaundice
Signs of Pancreatic Cancer?
Painless jaundice (maybe epigastric to back pain) NEW onset diabetes mellitus in an older person
Signs of Pancreatic Cancer?
Painless jaundice (maybe epigastric to back pain) NEW onset diabetes mellitus in an older person
What signs will be (+) with Pancreatic Cancer?
Trousseau sign of malignancy - migratory thrombophlebitis
Courvoisier sign
Courvoisier sign
Enlarged, non-tender gallbladder due to underlying mass
- sign of pancreatic cancer
What marker will be increased with Pancreatic Cancer?
CA 19-9
What marker will be increased with Pancreatic Cancer?
CA 19-9
Treatment for Pancreatic Cancer?
Whipple surgery (removes head of pancreas) Chemo
Amylase of Lipase - which is more accurate to the pancreas?
LIPASE
