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Block 4: SD 2 Week 10 > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

iWhat is acute pancreatitis?

A

inflammatory process in which pancreatic enzymes are activated and cause auto digestion of gland

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2
Q

What are some obstructive causes of acute pancreatitis?

A
  1. gallstones
  2. tumors ampullarf or pancreatic tumors
  3. hypertensive sphincter of Oddi
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3
Q

What are some major toxins that can contribute to acute pancreatitis?

A

Ethyl alcohol
excessive cholinergic stimulation
■ Scorpion venom
■ Organophosphorus insecticides
Drugs – Methyl-dopa, Tetracycline,
Thiazides, furosemide, sulfonamides

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4
Q

How can hypercalcemia cause acute pancreatitis? How does acute pancreatitis concurrently lead to hypocalcemia?

A

because hypercalcemia increases ductal permeability so the ducts carrying the pancreatic enzymes go back to the acinar cells and pancreatitis results.

Later because of increase of FFA in the blood that aren’t broken down there is hypocalcemia. This is because FFA combine with Ca

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5
Q

What are some infections that may cause acute pancreatitis? (Viral)

A

Viral:
■ mumps,
■ rubella,
■ hepatitis A, B, C
■ coxsackievirus B,
■ adenovirus,
■ cytomegalovirus,
■ varicella,
■ Epstein-Barr,
■ human immunodeficiency virus

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6
Q

What are some bacterial causes of acute pancreatitis?

A

Bacterial:
Salmonella
Shigella
mycoplasma,
Campylobacter jejuni,
tuberculosis,
Legionella,
Leptospirosis

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7
Q

What types of vasculitis can lead to acute pancreatitis?

A

systemic lupus erythematous
polyarteritis nodosa

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8
Q

What are some clinical features of acute pancreatitis?

A

Hallmark is persistent upper abdominal pain

Usually in the epigastric region

Usually accompanied by N+V

Post prandial esp fatty meals

After alcohol ingestion

The pain may radiate to the back

Patients bend forward

supine position may exacerbate the pain

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9
Q

How does CRP provide some indication of the prognosis?

A

it provides the degree of inflammation

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10
Q

Higher levels of CRP correlate with propensity towards what?

A

organ failure

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11
Q

Why should you include chest X-ray in evaluation of the acute pancreatitis?

A

Because in severe acute pancreatitis there can be severe pl effusion ARDS (Acute respiratory distress syndrome)

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12
Q

What is the best diagnostic test for acute pancreatitis?

A

CT

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13
Q

Prognosis of acute pancreatitis?

A

not bad mortality of 5% to 10%

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14
Q

Enteral nutrition using what type of tube is actually superior to TPN?

A

nasojejunal tube placed below ligament of Treitz

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15
Q

What are some medications that may be implicated in the treatment of acute pancreatitis?

A

■Meds –

acid suppression
antiemetics
pain control
opiate analgesics

prophylactic antibiotics

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16
Q

What are some prophylactic antibiotics implicated in the treatment of acute cholecystitis?

A

carbapenems or fluroquinolones and metronidazole

17
Q

What type of meds should be used (what bacteria should be targeted) when trying to treat acute pancreatitis caused by infections below the diaphragm?

A

gram negative and anaerobic coverage

18
Q

What is the most common complication of acute pancreatitis?

A

pseudocysts

19
Q

What is the gold standard for detection of pancreatic necrosis?

A

dynamic contrast-enhanced CT

20
Q

Describe what pseudocyst are.

A

collection of pancreatic juice, cellular debris, tissue and blood enclosed by a wall of granulation and fibrous tissue

21
Q

What is chronic pancreatitis?

A

inflammation, fibrosis, and atrophy of acinar cells resulting from chronic inflammation

22
Q

What is the most common nonobstructive cause of chronic pancreatitis?

A

chronic alcoholism

23
Q

Does gallstone pancreatitis lead to chronic pancreatitis?

A

almost never

24
Q

What are some major complications that can come from having chronic pancreatitis?

A

steatorrhea (when lipase decreased to <10%)

DM late complication

pancreatic cancer

pseudocysts

25
Q

Hemoperitoneum is associated with what sign upon physical examination?

A

Cullen’s sign

26
Q

Is Cullen sign of periumbilical ecchymosis associated with retroperitoneal or abdominal wall hemorrhage?

A

yes

27
Q

What are some labs that can be done to assess for chronic pancreatitis?

A

24 hour stool fat analysis

serum
lipase
amylase
calcium, renal panel, LFTs, glucose, TGs, etc

urine amylase/lipase in acute

fecal elastase

28
Q

How does calcification appear in chronic pancreatitis upon completing a CT?

A

speckled areas within the pancreas

29
Q

T/F. 90% of pancreatic tumors are mucinous adenocaricnomas of ductal origin.

A

True

30
Q

What are some major risks to getting pancreatic cancer?

A

cigarette smoking

beer drinking

31
Q

What type of jaundice can you have when having pancreatic cancer?

A

painless

32
Q

Describe pain of pancreatic cancer.

A

once invasive- vague, dull, constant epigastric pain; back pain

33
Q

Why do you get the characteristic dull constant epigastric pain; back pain associated with pancreatic cancer?

A

due to retroperitoneal extension or perineurial infiltration by tumor

34
Q

Prognosis of one with pancreatic cancer?

A

grim

35
Q

What are the best predictors of long-term survival after surgery?

A

a tumor diameter of less than 3 cm

no nodal involvement

negative resection margins

Block 4: SD 2 Week 10 (8 decks)

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