Pancreatitis Flashcards
Acute pancreatitis is an inflammation of the pancreas ___ (__ cells) mediating activation of pancreatic enzymes and ___
parenchyma
acinar
autodigestion
We need 2/3 of the following criteria to diagnose pancreatitis (Atlanta):
- typical pancreatitis ___ pain
- X3 elevated ___/___ levels
- ___ showing an inflammatory process in the pancreas (__/__/__)
abdominal
amylase/lipase
imaging (CT/MRI/US)
The pancreatic enzymes get activated when coming in touch with __ in the __
HCO3
duodenum
I GET SMASHED
Idiopathic Gallstone Ethanol Trauma Steroids Mumps/Malignancy Autoimmune Scorpion sting Hypertriglyceridemia/Hypercalcemia ERCP Drugs (tetracycline/thiazide/steroids)
Clinical presentation of pancreatitis includes ___ pain (acute, dull, and stable) radiating to the back in a __ like manner, relieved when ___, usually with __ and __. The maximal pain within - minutes and lasting for hours.
epigastric belt leaning nausea and vomiting 10-20
Physical examination of pancreatitis includes: (6)
fever tachycardia distended abdomen epigastric sensitivity guarding ileus
What are the three typical signs for hemorrhagic pancreatitis (retroperitoneal bleeding)?
__ (periumbilical)
__ (flanks)
__ (inguinal)
Cullen’s (periumbilical)
Grey turner (flanks)
Fox (inguinal)
___ is more sensitive and specific than __ when considering pancreatitis
lipase
amylase
Amylase and lipase have no ___ with the severity of pancreatitis
correlation
Elevated amylase can occur due to pancreatitis but also __, intestinal ___, any abdominal ___ process, etc…
vomiting
ischemia
inflammatory
Amylase levels increase in the first ___ hours, and then start to decrease. Afterwards we need to look for amylase in the __
24
urine
Lipase stays elevated longer than amylase, picking after ___ hours
48
Beside amylase and lipase, important pancreatitis laboratory markers include transaminase (__/__) and __. Remember to also look for elevated ___
AST/ALT
bilirubin
lactate
What are the two pancreatitis types?
mild AP- interstitial ___ (__%)
severe AP- ___ pancreatitis (__%)
edematous (85%)
necrotizing (15%)
Interstitial edematous pancreatitis is ___ limited, without tissue ___. CT is not a __ examination. Treatment is ___ and patients recover within a week.
self
necrosis
routine
conservative
Necrotizing pancreatitis should not be examined with __ imaging to show ___ because to see it, - days should pass. When suspecting infection use ___, start wide __, and consider __ the abscess
CT necrosis 3-5 FNA Abx (imipenem) draining
Suspect infected pancreatic necrosis when a ___ patient becomes acutely ___ after __ days, developing __/__
stable
septic
7
MOF/SIRS
The main complications of AP are divided into: __ and __.
systemic
local
The main systemic complications of AP are: ___ shock, __, breaking the __ __ barrier, hypo__
hypovolemic
SIRS
blood bowel
calcemia
The main local complications of AP are: ___ and ___ pancreatitis, __ pancreatitis, acute __ collection, pseudo__.
necrotizing infected hemorrhagic fluid cyst
