Pancreatitis Flashcards
iWhat is acute pancreatitis?
inflammatory process in which pancreatic enzymes are activated and cause auto digestion of gland
What are some obstructive causes of acute pancreatitis?
- gallstones
- tumors ampullarf or pancreatic tumors
- hypertensive sphincter of Oddi
What are some major toxins that can contribute to acute pancreatitis?
Ethyl alcohol
excessive cholinergic stimulation
■ Scorpion venom
■ Organophosphorus insecticides
Drugs – Methyl-dopa, Tetracycline,
Thiazides, furosemide, sulfonamides
How can hypercalcemia cause acute pancreatitis? How does acute pancreatitis concurrently lead to hypocalcemia?
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
What are some infections that may cause acute pancreatitis? (Viral)
Viral:
■ mumps,
■ rubella,
■ hepatitis A, B, C
■ coxsackievirus B,
■ adenovirus,
■ cytomegalovirus,
■ varicella,
■ Epstein-Barr,
■ human immunodeficiency virus
What are some bacterial causes of acute pancreatitis?
Bacterial:
Salmonella
Shigella
mycoplasma,
Campylobacter jejuni,
tuberculosis,
Legionella,
Leptospirosis
What types of vasculitis can lead to acute pancreatitis?
systemic lupus erythematous
polyarteritis nodosa
What are some clinical features of acute pancreatitis?
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
How does CRP provide some indication of the prognosis?
it provides the degree of inflammation
Higher levels of CRP correlate with propensity towards what?
organ failure
Why should you include chest X-ray in evaluation of the acute pancreatitis?
Because in severe acute pancreatitis there can be severe pl effusion ARDS (Acute respiratory distress syndrome)
What is the best diagnostic test for acute pancreatitis?
CT
Prognosis of acute pancreatitis?
not bad mortality of 5% to 10%
Enteral nutrition using what type of tube is actually superior to TPN?
nasojejunal tube placed below ligament of Treitz
What are some medications that may be implicated in the treatment of acute pancreatitis?
■Meds –
acid suppression
antiemetics
pain control
opiate analgesics
prophylactic antibiotics
What are some prophylactic antibiotics implicated in the treatment of acute cholecystitis?
carbapenems or fluroquinolones and metronidazole
What type of meds should be used (what bacteria should be targeted) when trying to treat acute pancreatitis caused by infections below the diaphragm?
gram negative and anaerobic coverage
What is the most common complication of acute pancreatitis?
pseudocysts
What is the gold standard for detection of pancreatic necrosis?
dynamic contrast-enhanced CT
Describe what pseudocyst are.
collection of pancreatic juice, cellular debris, tissue and blood enclosed by a wall of granulation and fibrous tissue
What is chronic pancreatitis?
inflammation, fibrosis, and atrophy of acinar cells resulting from chronic inflammation
What is the most common nonobstructive cause of chronic pancreatitis?
chronic alcoholism
Does gallstone pancreatitis lead to chronic pancreatitis?
almost never
What are some major complications that can come from having chronic pancreatitis?
steatorrhea (when lipase decreased to <10%)
DM late complication
pancreatic cancer
pseudocysts
Hemoperitoneum is associated with what sign upon physical examination?
Cullen’s sign
Is Cullen sign of periumbilical ecchymosis associated with retroperitoneal or abdominal wall hemorrhage?
yes
What are some labs that can be done to assess for chronic pancreatitis?
24 hour stool fat analysis
serum
lipase
amylase
calcium, renal panel, LFTs, glucose, TGs, etc
urine amylase/lipase in acute
fecal elastase
How does calcification appear in chronic pancreatitis upon completing a CT?
speckled areas within the pancreas
T/F. 90% of pancreatic tumors are mucinous adenocaricnomas of ductal origin.
True
What are some major risks to getting pancreatic cancer?
cigarette smoking
beer drinking
What type of jaundice can you have when having pancreatic cancer?
painless
Describe pain of pancreatic cancer.
once invasive- vague, dull, constant epigastric pain; back pain
Why do you get the characteristic dull constant epigastric pain; back pain associated with pancreatic cancer?
due to retroperitoneal extension or perineurial infiltration by tumor
Prognosis of one with pancreatic cancer?
grim
What are the best predictors of long-term survival after surgery?
a tumor diameter of less than 3 cm
no nodal involvement
negative resection margins
