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GI II Exam 2 > Pancreatic Patient > Flashcards

Pancreatic Patient Flashcards

1
Q

Differentials to consider for RUQ/Epigastric Pain

A
  1. Gallbladder Disease
  2. Hepatits
  3. Pancreatitis
  4. PUD
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2
Q

Describe the process that occurs in acute pancreatitis

A

Activation of digestive enzymes, kinases, and inflammatory markers leads to auto digestion of the pancreas.
Results in SAPONIFICATION that leads to hypocalcemia

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3
Q

2 most common causes of acute pancreatitis

A

Biliary Tract stones

Heavy alcohol use

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4
Q

Other less common causes of acute pancreatitis

A

Trauma
Medications
Infectious agents (mumps, CMV)
Autoimmune issues

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5
Q

What is a common chief complaint from patient’s presenting with acute pancreatitis?

A

Constant, boring pain that goes straight through them to their back.

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6
Q

PE findings of acute pancreatitis

A

Cullen/Gray Turner Sign (ecchymosis)
Chvostek and Trousseau signs (hypocalcemia)
ARDS

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7
Q

Diagnostic criteria for acute pancreatitis

A

2/3

  1. Epigastric pain
  2. 3xULN for Lipase (and amylase)
  3. CT changes
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8
Q

What would be seen on a CMP in a patient with acute pancreatitis?

A 
Hyperglycemia
Hyperbilirubinemia
Increased BUN
Elevated Creatinine
Elevated ALT 
Hypocalcemia
"Harry Herbert's manBUN Created ALTernative Calcium"
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9
Q

What are the 2 XR signs indicative of acute pancreatitis?

A

Sentinal Loop- air-filled SI in LLQ

Colon cutoff sign- gas filled Transverse colon

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10
Q

What is the first line treatment for acute pancreatitis

A

Fluid Resuscitation

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11
Q

Complications associated with acute pancreatitis

A
  1. 3rd spacing fluid leaks
  2. Pre-renal azotemia (most common form of kidney failure in hospitalized patients)
  3. Pleural Effusion
    * Dry intravascularly but edema everywhere else; why you need to treat fluids first
  4. Pseudocysts
  5. ARDS
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12
Q

Ranson Critera for acute pancreatitis severity upon admission

A 
"GA-LAW": 3 or more= severe course with necrosis in 60-80% of patients 
Glucose>100 
Age>55
LDH>350
AST>250
WBC>16,000
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13
Q

Ranson Criteria for acute pancreatitis severity 48hrs after admission

A 
"C & HOBBS"
Calcium <8
Hct drop >10%
O2 (PaO2) <60mmHg
Base deficit >4
BUN increase >5
Sequestration of fluid >6L
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14
Q

BISAP score for acute pancreatitis at or within 24 hrs of admission

A 
Bun>25mg/dL
Impaired Mental status
SIRS: >2 of 4 
Age >60 
Pleural Effusion
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15
Q

APACHE II score

A

Just know higher the score the higher the mortality rate

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16
Q

What is a sign of infected pancreatic necrosis and what are common organisms to cause it?

A

Emphysematous Pancreatitis

  1. C. Perfringens
  2. E. Aerogenes
  3. E. Faecalis
    * Don’t think we need to memorize those but good to know
17
Q

Describe Chvostek Sign

A

twitching of facial muscles due to hypocalcemia

18
Q

Describe Trousseau sign related to hypocalcemia

A

hand postures when BP cuff is pumped up

19
Q

Which is a better prognostic indicator of pancreas function, Lipase or Amylase

A

Lipase: more specific to pancreatitis

20
Q

What is the most frequent cause of chronic pancreatitis?

A

Alcoholism

21
Q

PE findings of chronic pancreatitis

A 
epigastric pain
steatorrhea 
WL
Fatigue 
Pain
22
Q

Diagnostic labs for chronic pancreatitis

A

Lipase/Amylase
Steatorrhea
DECREASED FECAL ELASTASE < 100 mcg

23
Q

What is usually seen on XR in chronic pancreatitis patients

A

Pancreaticolithiasis

24
Q

What can be seen on CT that would probe workup for possible pancreatic cancer?

A

tumefactive chronic pancreatitis (chronic pancreatitis with a mass and/or obstructive jaundice)

25
Q

TIGAR-O Chronic Pancreatitis

A 
Toxic-Metabolic: EtOH
Idiopathic
Genetic: CF
Autoimmune- Celiac/IgG4 disease
Recurrent- 36% of recurrent acute pancreatitis pt's
Obstructive
26
Q

What is the main cause of death in those with chronic pancreatitis?

A

Cancer

27
Q

3 treatments for chronic pancreatitis

A
  1. supportive
  2. Pain control
  3. Pancreatic enzyme supplementation
28
Q

Pancreatic function tests

A

Fecal Elastase is most indicative

Low in insufficiency

29
Q

What endocrine related disorder do close to 80% of chronic pancreatitis pt’s develop?

A

DM

30
Q

67 y/o patient presents with weight loss and new onset DM. What is in your differential?

A

Pancreatic Cancer

  • > 65
  • New onset DM
  • Painless Jaundice
31
Q

Trousseau sign of Malignancy

A

aka Migratory Thromboplebitis
- repeated attacks of multiple venous thrombosis at different sites. Due to overproduction of coagulation factors from cancer cells

32
Q

Courvoisier Sign

A

enlarged, palpable gallbladder in patients with obstructive jaundice

33
Q

MEN Type 1 can be diagnosed by which findings

A

2/3:

  1. Hypercalcemia with increased PTH (Parathyroid)
  2. Gastrinoma (ZES) or Insulinoma that leads to hypoglycemia
  3. Acromegaly or Cushing Disease

Andre the Giant

34
Q

MEN type 2A

A

Thyroid- elevated calcitonin (hypocalcemia)
Adrenal- elevated catecholamines
PT- Hypercalcemia with increased PTH

35
Q

MEN Type 2B

A

Marfanoid type with neuromas of lips and tongue

*Not HY

GI II Exam 2 (16 decks)

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