Pancreatitis

Question 1

Acute pancreatitis is an inflammation of the pancreas ___ (__ cells) mediating activation of pancreatic enzymes and ___

Answer 1

parenchyma
acinar
autodigestion

Question 2

We need 2/3 of the following criteria to diagnose pancreatitis (Atlanta):

1. typical pancreatitis ___ pain
2. X3 elevated ___/___ levels
3. ___ showing an inflammatory process in the pancreas (__/__/__)

Answer 2

abdominal
amylase/lipase
imaging (CT/MRI/US)

Question 3

The pancreatic enzymes get activated when coming in touch with __ in the __

Answer 3

HCO3

duodenum

Question 4

I GET SMASHED

Answer 4

Idiopathic
Gallstone
Ethanol
Trauma
Steroids
Mumps/Malignancy
Autoimmune
Scorpion sting
Hypertriglyceridemia/Hypercalcemia
ERCP
Drugs (tetracycline/thiazide/steroids)

Question 5

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.

Answer 5

epigastric
belt
leaning
nausea and vomiting
10-20

Question 6

Physical examination of pancreatitis includes: (6)

Answer 6

fever
tachycardia
distended abdomen
epigastric sensitivity
guarding
ileus

Question 7

What are the three typical signs for hemorrhagic pancreatitis (retroperitoneal bleeding)?
__ (periumbilical)
__ (flanks)
__ (inguinal)

Answer 7

Cullen’s (periumbilical)
Grey turner (flanks)
Fox (inguinal)

Question 8

___ is more sensitive and specific than __ when considering pancreatitis

Answer 8

lipase

amylase

Question 9

Amylase and lipase have no ___ with the severity of pancreatitis

Answer 9

correlation

Question 10

Elevated amylase can occur due to pancreatitis but also __, intestinal ___, any abdominal ___ process, etc…

Answer 10

vomiting
ischemia
inflammatory

Question 11

Amylase levels increase in the first ___ hours, and then start to decrease. Afterwards we need to look for amylase in the __

Answer 11

24

urine

Question 12

Lipase stays elevated longer than amylase, picking after ___ hours

Answer 12

48

Question 13

Beside amylase and lipase, important pancreatitis laboratory markers include transaminase (__/__) and __. Remember to also look for elevated ___

Answer 13

AST/ALT
bilirubin
lactate

Question 14

What are the two pancreatitis types?
mild AP- interstitial ___ (__%)
severe AP- ___ pancreatitis (__%)

Answer 14

edematous (85%)

necrotizing (15%)

Question 15

Interstitial edematous pancreatitis is ___ limited, without tissue ___. CT is not a __ examination. Treatment is ___ and patients recover within a week.

Answer 15

self
necrosis
routine
conservative

Question 16

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

Answer 16

CT
necrosis
3-5
FNA
Abx (imipenem)
draining

Question 17

Suspect infected pancreatic necrosis when a ___ patient becomes acutely ___ after __ days, developing __/__

Answer 17

stable
septic
7
MOF/SIRS

Question 18

The main complications of AP are divided into: __ and __.

Answer 18

systemic

local

Question 19

The main systemic complications of AP are: ___ shock, __, breaking the __ __ barrier, hypo__

Answer 19

hypovolemic
SIRS
blood bowel
calcemia

Question 20

The main local complications of AP are: ___ and ___ pancreatitis, __ pancreatitis, acute __ collection, pseudo__.

Answer 20

necrotizing
infected
hemorrhagic
fluid
cyst