Pancreatitis

Question 1

Two pulmonary risks with pancreatitis?

Answer 1

Pleural effusions from 3rd spacing and ARDS

Question 2

Two possible signs from bleeding r/t necrotizing pancreatiits?

Answer 2

Get-Turners sign and Cullen’s sign

Question 3

What is Cullen’s sign?

Answer 3

Peri-umbilical bruising

Question 4

What is Grey-Turners sign?

Answer 4

Flank bruising

Question 5

How can pancreatitis affect blood pressure?

Answer 5

Causes hypotension r/t
1. lowered albumin levels that lowers serum oncotic pressure leading to 3rd spacing
2. Myocardial depressant factor- decreases CO
3. Fluid loss 2nd to vomiting

Question 6

What can inflammation of the pancreas and surrounding tissues lead to the release of?

Answer 6

1. myocardial depressant factor
2. histamine
3. prostaglandin
4. Kallikrein > bradykinan > cap. permeability and
   vasodilation.

Question 7

How is decreased CO from MDF release treated? (4 medications)

Answer 7

1. steroids
2. prostaglandins
3. captopril
4. imidazole

Question 8

What can cause ALI/ARDS in pancreatitis?

Answer 8

1. Inc. capillary permeability
2. pro-inflammatory substances released from damaged cells (prostaglandin and histamine

Question 9

What causes atelectasis in pancreatitis?

Answer 9

1. Splinting from pain with breathing
2. decreased movement, bedrest
3. abdominal distention
4. decreased mechanical inspiration volumes

Question 10

How do pleural effusions develop in pancreatitis?

Answer 10

1. 3rd spacing due to lowered albumin levels lead to lowered oncotic pressure
2. Increased capillary permeability r/t histamine and prostaglandin release
3. propensity to develop on the left side

Question 11

What metric can be used to measure mortality in acute pancreatitis patients?

Answer 11

Ranson’s criteria based on 48 hour labs and/or APACHEII score

Question 12

Describe pancreatic abscess formation in acute pancreatitis?
What is the primary cause and time frame for development?

Answer 12

1. Usually develops 4 weeks after acute attack
2. caused by translocation of intestinal bacteria

Question 13

What is a pancreatic pseudocyst?

Answer 13

A fibrin encapsulation of necrotic tissue, fluid, blood and debris that usually self=resolves

Question 14

How are clotting factors affected by acute pancreatitis?

Answer 14

1. Decreased, specifically VIII and fibrinogen

Question 15

What are some affects of low albumin levels in pancreatitis?

Answer 15

1. lowered Ca+ levels
   a. can lead to QT prolongation
   b. muscle weakness/tremors
2. lowered serum oncotic pressure
   a. leads to 3rd spacing

Question 16

How are renal functions affected in acute pancreatitis?

Answer 16

There may be pre-renal failure 2nd to decreased blood flow/hypotension and fluid volume deficits from 3rd spacing and vomiting.

Question 17

What causes Kallikrein to be released?

Answer 17

Pancreatic acinar cells be autodigested by Trypsin

Question 18

How does alcohol influence pancreatitis?

Answer 18

May cause an increase in triglycerides leading to ischemia and an increase in pancreatic O2 demands regardless of hemodynamic patterns