Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IM GASTRO > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q
  • leading cause of acute pancreatitis

- second most common

A
  • Gallstones

- alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • pancreas blood supply maintained

- which is generally self-limited

A

nterstitial pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • pancreas blood supply interrupted
  • the extent of necrosis may correlate with the severity of the
    attack and its systemic complications
A

Necrotizing pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  • accepted pathogenic
  • proteolytic enzymes (e.g., trypsinogen, chymotrypsinogen,
    proelastase, and lipolytic enzymes such as phospholipase A2) are activated in the pancreas acinar cell rather than in the intestinal lumen
A

Autodigestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Factors that facilitate premature

activation of trypsin

A
  • Endotoxins
  • Exotoxins
  • viral infection
  • Ischemia
  • oxidative stress
  • lysosomal calcium
  • direct trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • characterized by intrapancreatic digestive enzyme activation and acinar cell injury
  • Trypsin activation
A

Initial phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

activation, chemoattraction, and sequestration of leukocytes
and macrophages in the pancreasenhanced intrapancreatic inflammatory reaction

A

Second phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

due to the effects of activated proteolytic enzymes and
cytokines, released by the inflamed pancreas, on distant
organs

A

Third phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Genetic variants associated with susceptibility to pancreatitis

A
  • cationic trypsinogen gene (PRSS1)
  • pancreatic secretory trypsin inhibitor (SP/NKz)
  • the cystic fibrosis transmembrane conductance regulator
    gene (CFTR)
  • the chymotrypsin C gene (CTRC)
  • the calcium-sensing receptor (CASR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • major symptom
  • mild discomfort to severe, constant, and incapacitating distress
  • steady and boring in character, is located in the epigastrium and periumbilical region, and may radiate to the back, chest, flanks, and lower abdomen
A

Abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • A faint blue discoloration around the umbilicus

- Due to hemoperitoneum

A

Cullen’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of Pnacreatitis

A
  • Abdominal pain
  • Nausea/ vomiting
  • Abdominal distention
  • distressed and anxious
  • Low-grade fever, tachycardia, and hypotension
  • hypovolemic Shock
  • Jaundice (rare)
  • Erythematous skin nodules
  • basilar rales, atelectasis, and pleural effusion (left sided)
  • Abdominal tenderness and muscle rigidity
  • Diminished or absent bowel sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • a blue-red-purple or green-brown discoloration of the
    flanks
  • tissue catabolism of hemoglobin from severe necrotizing pancreatitis with hemorrhage
A

Turner’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • Return to normal after 3-7 days

- acidemia (arterial pH $7.32)

A

Serum amylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • Preferred test
  • nocorrelation between the severity of pancreatitis and the degree of serum lipase and amylase elevations
  • remain elevated for 7-14 days
A

Serum Lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LABORATORY DATA OF PANCREATITIS

  • Leukocytosis
  • Hemoconcentration- Hematocrit
  • BUN
  • glycemia
  • calcemia
  • bilirubinemia
  • Serum alkaline phosphatase and aspartate aminotransferase levels
  • triglyceridemia
  • Hypoxemia
  • ECG -
A
  • Leukocytosis -15,000—20,000 leukocytes/uUL)
  • Hemoconcentration- Hematocrit of >44%
  • BUN >22mq/dl
  • Hypoglycemia
  • Hypocalcemia
  • Hyperbilirubinemia (serum bilirubin >4.0 mg/dL)
  • Serum alkaline phosphatase and aspartate aminotransferase levels are also transiently elevated
  • Hypertriglyceridemia
  • Hypoxemia (arterial PO2 <60 mm Hg
  • ECG - ST-segment and T-wave abnormalities
17
Q
  • initial diagnostic imaging modality
  • most useful to evaluate for gallstone disease and the
    pancreatic head
A

Abdominal ultrasound

18
Q

CT scan

Revised Atlanta Criteria of pancreatitis

A

1) necrotizing pancreatitis
2) acute pancreatic fluid collection
3) pancreatic pseudocyst
4) acute necrotic collection (ANC)
C) walled-off necrosis (WON)

19
Q

DIAGNOSIS Criteria of pancreatitis

A

two of the three criteria

  • (1) typical abdominal pain in the epigastrium that may
    radiate to the back
  • (2) threefold or greater elevation in serum lipase and/or
    amylase, an
  • (3) confirmatory findings of acute pancreatitis on crosssectional abdominal imaging
20
Q
  • lasts 1-2 weeks
  • severity is defined by clinical parameters rather than morphologic findings.
  • Organ failure is defined as a score of 2 or more for one of these three organ systems using the modified Marshall scoring system.
  • respiratory, cardiovascular, and renal
  • Persistent organ failure (>48 h) is the most important clinical finding in regard to severity of the acute pancreatitis episode
A

Early phase of acute pancreatitis

21
Q
  • > 2 weeks
  • characterized by a protracted course of illness
  • require imaging to evaluate for local complications
  • persistent organ failure- important clinical parameter of severity
  • may require supportive measures- renal dialysis, ventilator support, supplemental nutrition via the nasojejunal or parenteral route
  • necrotizing pancreatitis- radiographic feature of greatest importance
A

Late phase

22
Q

Severity Classifications

  • without local complications or organ failure
  • self-limited and subsides spontaneously
  • within 3-7 days after treatment is instituted
  • Oralintake resumed ifthe patient is hungry, has normal
    bowel function, and is without nausea and vomiting
  • aclear or full liquid diet has been recommended for the initial meal
  • a low-fat solid diet
A

Mild acute pancreatitis

23
Q

Severity Classifications

  • characterized by transient organ failure
  • (resolves in <48h
  • local or systemic complications in the absence of persistent organ failure
  • may develop a local complication such as a fluid collection that requires a prolonged hospitalization >1 week
A

Moderately severe acute pancreatitis

24
Q

Severity Classifications

  • is characterized by persistent organ failure (>48 h)
  • Organ failure can be single or multiple
  • CT scan or MRI should be obtained to assess for necrosis
    and/or complications
  • management is dictated by clinical symptoms, evidence
    of infection, maturity of fluid collection, and clinical stability of the patient
  • Prophylactic antibiotics are not recommended
A

Severe acute pancreatitis

25
Q

Types of Pancreatitis

  • 90-95% of admissions for acute pancreatitis
  • characterized by diffuse gland enlargement, homogenous contrast enhancement, and mild inflammatory changes or peripancreatic stranding
  • Symptoms resolve with a week of hospitalization
A

Interstitial pancreatitis

26
Q

Types of Pancreatitis

  • 5-10% of acute pancreatitis admissions
  • does not evolve until several days of hospitalization
  • characterized by lack of pancreatic parenchymal enhancement by intravenous contrast agent and/or presence of findings of peripancreatic necrosis.
A

Necrotizing pancreatitis

27
Q

ACUTE PANCREATITIS MANAGEMENT

A
  • Fluid Resuscitation
  • lactated Ringer’s or normal saline
  • initially bolused at 15-20 mL/kg (1050-1400 mL),
  • followed by 2-3 mL/kg per hour (200-250 mL/h), to maintain urine output >0.5 mL/kg per hour.
  • targeted resuscitation strategy with measurement of hematocrit and BUN every 8-12 h
  • A rise in hematocrit or BUN- repeat volume challenge with a 2-L crystalloid bolus followed by increasing the fluid rate by 1.5 mg/kg per hour
  • The patient is made NPO to rest the pancreas and is
    given intravenous narcotic analgesics to control abdominal pain and supplemental oxygen (2 L) via nasal cannula
28
Q

Markers of Severity At Admission or within 24hr

SIRS—defined by presence of 2 or more criteria:

  • Core temperature <
  • Heart rate
  • Respirations: or Pco2
  • White blood cell count
  • APACHE
  • Hemoconcentration ()
  • Admission BUN
  • BISAP Score
  • (B) BUN
  • (I) mental status
  • (s) sirs:
  • (A) Age
  • (P) Pleural
  • Organ (Modified Marshall Score)
  • Cardiovascular: systolic BP: , heart rate:
  • Pulmonary: Pao2
  • Renal: serum creatinine
A

SIRS—defined by presence of 2 or more criteria:

  • Core temperature <36° or >38°C
  • Heart rate >90 beats/min
  • Respirations >20/min or Peo, <32 mmHg
  • White blood cell count >12,000/pL, <4000/yL, or 10% bands
  • APACHE II
  • Hemoconcentration (hematocrit >44%)
  • Admission BUN (>22 mg/dL)
  • BISAP Score
  • (B) BUN >25 mg/dL
  • (I) Impaired mental status
  • (s) sirs: >/=2 of 4 present
  • (A) Age >60 years
  • (P) Pleural effusion
  • Organ failure (Modified Marshall Score)
  • Cardiovascular: systolic BP <90 mmHg, heart rate >130 BPM
  • Pulmonary: Pao2 <60 mm Hg
  • Renal: serum creatinine >2.0 mg
29
Q
  • ascending cholangitis (rising white blood cell count, increasing liver enzymes) should undergo ERCP within
    24-48 h of admission
  • increased risk of recurrence
  • cholecystectomy during the same admission or within 4—
    6 weeks of discharge.
  • non surgical candidates — endoscopic biliary sphincterotomy before discharge
A

GALLSTONE PANCREATITIS

30
Q
  • Serum triglycerides >1000 mg/dL
  • insulin, heparin, or plasmapheresis
  • Outpatient therapies: control of diabetes if present, lipidlowering agents, weight loss, and avoidance of drugs that elevate lipid levels.
A

HYPERTRIGLYCERIDEMIA

31
Q

Nutritional Therapy for Pancreatitis

A
  • low-fat solid diet after the abdominal pain has resolved
  • Enteral nutrition should be considered 2-3 days after
    admission in subjects with more severe pancreatitis
    instead of total parenteral nutrition (TPN)
  • Enteral feeding
    + maintains gut barrier integrity
    + limits bacterial translocation
    + less expensive
    + has fewer complications than TPN
32
Q

Complications of Acute Pancreatitis

A
  • Local Necrosis (Sterile, Infected)
  • Walled-off necrosis
  • Pancreatic fluid collections
  • Pancreatic pseudocyst
  • Disruption of main pancreatic duct
  • Thrombosis of blood vessels (splenic vein, portal vein)
  • Pancreatic enteric fistula
  • Bowel infarction
  • Obstructive jaundice

IM GASTRO (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions