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MEDICINA INTERNA > PANCREATITIS > Flashcards

PANCREATITIS Flashcards

1
Q

Pancretitis Aguda (def y clas anatomapatologica)

A

Edematosa Intersticial: Inflamacion aguda del parenquima pancreatico y del tej peripancreatico.
Necrotica: asociada a necrosis tisular del pancreas y del tej peripancreatico.

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2
Q

Pancreatitis (etiologia)

A
  • Biliar (40% mujeres)
  • Alcolica (30% mas hombres)
  • Drogas (ac valproico, furo, enalapril, amiodarona, paracetamol)
    -Pos CPRE
  • Metabolicas: hipertrigliceridemia (>1000)
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3
Q

Pancreatitis (enzimas)

A

Tripsina Activada
Quimiotripsina
Elastasa
Fosfolipasa A2
Lipasa

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4
Q

Pancreatitis (clas severidad)

A

LEVE
MODERADAMENTE SEVERA
SEVERA

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5
Q

Pancreatitis (clas leve)

A

Sin falla organica
Resolucion < 48h
Sin complicaciones focales o sistemicas

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6
Q

Pancreatitis (clas. mode severa)

A

Falla organica que resuelve < 48h
Presenta complicaciones focales o sistemicas

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7
Q

Pancreatitis (clas. severa)

A

Falla de organos persistente
> 48h

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8
Q

Pancreatitis (clinica)

A

1)Dolor Abdominal (hemi-cinturon) periumbilical - dorso izq ( DOLOR SORDO, INTENSO)
2) Anorexia, nauseas, vomitos.
3) Fiebre ? ( no significa que es infecciosa) - IL1

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9
Q

Pancreatitis (posicion de alivio)

A

Genupectoral o Mahometana

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10
Q

Pancreatitis ( Sig Gray-Turner)

A

Equimosis en flancos

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11
Q

Pancretitis (Sig Cullen)

A

Equimosis periumbilical

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12
Q

Pancreatitis (Sig Fox)

A

Equimosis base de penis

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13
Q

Pancreatitis (Dx - amilasa)

A

Amilasa serica ( 2-12h del inicio/ normal 3-4d)
N 60-120U/L
Sospecha >400 U/L
Confirmado 800-1000U/L

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14
Q

Pancreatitis (Dx - Lipasa)

A

Más precisa
Tarda mas y dura más
Despues de las 72h
Mantiene 8-14d
N : 0-200 U/L
PA: 3x200= 600

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15
Q

Pancreatitis (Ecografia)

A

Aumento difuso e hipoecoico del pancreas (edematoso) Aumento de volumen; si es necrohemorragico hay liq libre en cavidad.

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16
Q

Pancreatitis (Criterios de Baltaza - TAC)

A

TAC
A : normal
B: aumento focal o difuso del pancreas
C: alteraciones inflamatorias leve peripancreaticas
D: coleccion de liq unicos en cara ant
E: dos o mas colecciones de liq proximas - o gas o absceso dentro del pancreas.

17
Q

Pancreatitis (Criterios de Baltaza - A)

A

A : normal sin alteraciones

18
Q

Pancreatitis (Criterios de Baltaza - B)

A

B: aumento focal o difuso del pancreas

19
Q

Pancreatitis (Criterios de Baltaza - C)

A

C: alteraciones inflamatorias leve peripancreaticas

20
Q

Pancreatitis (Criterios de Baltaza - D)

A

D: coleccion de liq unica en cara ant

21
Q

Pancreatitis (Criterios de Baltaza - E)

A

E: dos o mas colecciones de liq proximas - o gas o absceso dentro del pancreas.

22
Q

Pancreatitis (Conduta)

A

1) Medidas Generales
- NPO
- Posicion Semi Fowler
- CSV-CGE
2) Solucion Ringer Lactato 1000cc para via **
3) Medicamentos:
- Cloridrato de Meperidina 100mg/2ml, diluir en 8cc de agua destilada y aplicar 2ml cada 6h o
- Tramadol 50mg cada 8h
- Omeprazol 40mg EV c/12h
G
4) Hemograma completo, glicemia, proteinas, amilasa, lipasa, LDH, FA, Perfil Lipidico **
5) Ecografia Abdominal

23
Q

Pancreatitis (Criterios de Ranson)

A

Identificar a morbimortalidad del px, y si necesita mayores cuidados como UTI.
1) Biliar o No Biliar
2) Ingreso y 48h de Hospitalizacion

24
Q

Pancreatitis (Criterios de Ranson - Ingreso - parametros biliar) 5

A

Ingreso
- Edad >70
- Leucocitos >18000
- Glucosa >220
- LDH >400
- GOT >250

25
Q

Pancreatitis (Criterios de Ranson - Ingreso - parametros no biliar)

A

Ingreso
- Edad >55
- Leucocitos >16000
- Glucosa >200
- LDH >350
- GOT >250

26
Q

Pancreatitis (Criterios de Ranson - 48h - parametros biliar)

A

48h
- Caida del Hcto >10puntos
- Aumento BUN >2mg/dl
-Calcio serico <8
-Deficit base >5mEqL/L
-Deficit de volumen >4L

27
Q

Pancreatitis (Criterios de Ranson - 48h - parametros no biliar)

A

48h
- Caida del Hcto >10p
- Aumento BUN >5mg/dL
-Calcio serico <8mg/dL
-Deficit base >4 mEq/L
-paO2 <60mmHg
-Deficit de volumen >6L

28
Q

Pancreatitis (APACHE II)

A

Temperatura
PAM
FC
FR
PaO2
pH arterial
Na
K
Crea
Hcto
Leucocitos
Glasgow
HCO3
Edad
Enf asociadas

29
Q

Pancreatitis (BISAP)

A
30
Q

Pancreatitis (BISAP)

A

0-2 PA
3-5 PS

31
Q

Pancreatitis (BISAP)

A

MEDICINA INTERNA (16 decks)

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