Pancreatitis Flashcards
What issue?
(b) Abrupt onset (within minutes) epigastric abdominal pain
(c) Steady, ‘boring’, severe abdominal pain that is made worse with walking and lying supine.
(d) Many patients describe feeling relief with sitting upright and leaning forward.
(e) Pain typically radiates to the back
1) May radiate to the right or left lumbar spine
(f) Mild jaundice is common
(g) Nausea and vomiting almost always present
(h) Weakness, fever and anxiety
(i) Grey-Tuner and Cullen’s sign in severe disease
(j) Possible upper abdominal mass
Pancreatitis
Pancreatitis labs?
CBC: Leukocytosis (10,000-30,000/mcL)
GOLD STANDARD: Elevated serum Lipase is diagnostic
UA: Proteinuria, granular casts, glycosuria (10% of cases)
Glucometer: Hyperglycemia
Elevated serum lactic dehydrogenase.
Elevated aspartate aminotransferase
Gold Standard Imaging FOR PANCREATITIS?
CT scan is useful in showing enlarged pancreas and will demonstrated severity of disease
Most common causes of pancreatitis:
Alcohol
Gallstones
Passage of gallstones
Can obstruct the ampulla of _____, causing impaired extrusion of enzymes
into the duodenum leads to auto-digestion of pancreas tissue.
ampulla of Vater
_______ can cause auto-activation of pancreatic enzymes while still in the pancreas resulting in enzymatic destruction of pancreas.
Alcohol
What are some other causes of pancreatitis?
Iatrogenic, ERCP, trauma , hyperlipidemia, hypercalcemia, infections, certain drugs, vasculitis
Management/Treatment: Pancreatitis
What is the gold standard for uncomplicated pancreatitis?
NPO + aggressive fluid resuscitation
Treatment: Pancreatitis
1) NPO “rest pancreas:”
2) Fluids
-Lactated ringer solution may be preferable to normal saline
-Fluids: 5-10mL/kg/hr initially
3) Bed rest
4) Pain Control
-Ketorolac, Morphine, or Hydrocodone as needed
-Adequate pain control should be the goal
5) No indication for antibiotic use
Oral intake can be resumed when the patient is _______
largely free of pain
Management/Treatment: Pancreatitis
Overly aggressive fluid resuscitation may lead to ______ as well if patients
have cardiovascular or renal comorbidities.
morbidity
True/False
Management/Treatment: Pancreatitis
These patients tend to be very sick and require constant monitoring of fluid status and
vital signs.
True
Management/Treatment: Pancreatitis
If the patient is vomiting, what should you do?
-Nasogastric (NG) tube suction
-NPO “Rest Pancreas”
-Bed rest
True/False
Non-severe acute pancreatitis subsides spontaneously within several days.
True
Disposition: Pancreatitis
MEDEVAC!!!
