PANCREATITIS Flashcards
A 45-year-old male with a history of heavy alcohol consumption presents with severe upper abdominal pain, nausea, and vomiting. Laboratory tests show an elevated serum amylase and lipase. What is the most likely cause of his acute pancreatitis?
A. Gallstones
B. Hypertriglyceridemia
C. Alcohol
D. Endoscopic retrograde cholangiopancreatography (ERCP)
Correct Answer: C
Rationale: Alcohol is the second most common cause of acute pancreatitis in the United States, responsible for 15–30% of cases. Given the patient’s history of heavy alcohol consumption, it is the most likely cause in this scenario.
A 50-year-old female with a history of gallstones presents with severe abdominal pain, nausea, and vomiting. She has a history of similar episodes. Which of the following is the most likely cause of her acute pancreatitis?
A. Gallstones
B. Hypertriglyceridemia
C. Medications
D. Alcohol
Correct Answer: A
Rationale: Gallstones are the leading cause of acute pancreatitis, responsible for 30–60% of cases. The patient has a history of gallstones, which is the most likely cause of her recurrent pancreatitis.
A 38-year-old male with a history of chronic alcohol use presents with acute abdominal pain, nausea, vomiting, and elevated serum amylase and lipase levels. His triglyceride level is 1200 mg/dL. What is the most likely cause of his pancreatitis?
A. Gallstones
B. Alcohol
C. Hypertriglyceridemia
D. ERCP
Correct Answer: C
Rationale: Hypertriglyceridemia is the cause of acute pancreatitis in 1–4% of cases. Serum triglyceride levels >1000 mg/dL are often seen, and this patient has a triglyceride level of 1200 mg/dL, making hypertriglyceridemia the most likely cause.
A 40-year-old male with a history of alcohol use presents with acute pancreatitis. During examination, he develops a faint blue discoloration around the umbilicus. What does this finding most likely indicate?
A. Cullen’s sign
B. Turner’s sign
C. Jaundice
D. Subcutaneous fat necrosis
Correct Answer: A
Rationale: Cullen’s sign refers to blue discoloration around the umbilicus and is associated with hemoperitoneum in the context of severe pancreatitis. It reflects the severity of the condition, especially in cases of hemorrhagic pancreatitis.
A 58-year-old female with acute pancreatitis develops a left-sided pleural effusion. What is the most likely cause of this complication in the context of pancreatitis?
A. Atelectasis
B. Pulmonary embolism
C. Acute myocardial infarction
D. Systemic infection from translocation of gut bacteria
Correct Answer: A
Rationale: In acute pancreatitis, pleural effusion (most often left-sided) and atelectasis are common pulmonary complications. These are due to diaphragmatic irritation and the systemic inflammatory response
A 50-year-old male with acute pancreatitis presents with a blue-red discoloration of the flanks. What does this finding suggest?
A. Turner’s sign
B. Jaundice
C. Hepatomegaly
D. Ascites
Correct Answer: A
Rationale: Turner’s sign is characterized by blue-red discoloration of the flanks and reflects hemorrhagic pancreatitis. It is a sign of severe necrotizing pancreatitis with associated hemorrhage.
A 45-year-old female with acute pancreatitis is found to have abdominal distention and diminished bowel sounds. Which of the following best explains this finding?
A. Gastric and intestinal hypomotility
B. Bowel obstruction due to adhesions
C. Perforated ulcer
D. Acute cholecystitis
Correct Answer: A
Rationale: Gastric and intestinal hypomotility is a common feature of acute pancreatitis, leading to abdominal distention and diminished bowel sounds due to impaired gastrointestinal motility.
A 65-year-old patient with acute pancreatitis presents with hyperglycemia. Which of the following is most likely contributing to this patient’s elevated blood glucose levels?
A. Increased release of insulin
B. Decreased release of glucagon
C. Increased release of glucocorticoids
D. Decreased output of catecholamines
Correct Answer: C
Rationale: Hyperglycemia in acute pancreatitis occurs due to decreased insulin release, increased glucagon release, and increased output of adrenal glucocorticoids and catecholamines, all of which contribute to increased blood glucose levels.
A patient with acute pancreatitis has an elevation in serum bilirubin to 4.5 mg/dL. What is the most likely cause of this finding?
A. Chronic liver disease
B. Gallstone obstruction of the bile duct
C. Acute viral hepatitis
D. Hepatic congestion
Correct Answer: B
Rationale: Hyperbilirubinemia in acute pancreatitis, often transient, may be caused by extrinsic compression from peripancreatic edema, pancreatic head mass, or common bile duct obstruction due to a gallstone.
A 58-year-old male with severe acute pancreatitis develops hypoxemia with an arterial oxygen saturation of 60%. What complication is he most likely developing?
A. Acute respiratory distress syndrome (ARDS)
B. Pulmonary embolism
C. Myocardial infarction
D. Pleural effusion
Correct Answer: A
Rationale: Hypoxemia (arterial Po2 ≤60 mmHg) is seen in 5–10% of patients with acute pancreatitis and often precedes the development of acute respiratory distress syndrome (ARDS), a life-threatening complication.
A 50-year-old patient presents with acute epigastric pain that radiates to the back. His serum amylase is three times the normal value, and a CT scan confirms acute pancreatitis. However, his hematocrit is found to be 45%, and his BUN is 24 mg/dL. What do these findings suggest regarding the severity of his condition?
A. No concern for severity; this is a mild case of acute pancreatitis.
B. The patient is at risk for more severe pancreatitis and possible complications.
C. The patient’s condition will improve without intervention.
D. The patient is likely in acute kidney failure unrelated to pancreatitis.
Correct Answer: B
Rationale: Hemoconcentration (hematocrit >44%) and azotemia (BUN >22 mg/dL) are markers of more severe disease in acute pancreatitis and are associated with a higher risk for complications.
In the early phase of acute pancreatitis (<2 weeks), which clinical parameter is most important in defining the severity of the disease?
A. CT imaging findings showing pancreatic necrosis.
B. Persistent organ failure for more than 48 hours.
C. The presence of Jaundice or abdominal tenderness.
D. Serum amylase and lipase levels.
Correct Answer: B
Rationale: In the early phase of acute pancreatitis, persistent organ failure (lasting more than 48 hours) is the most important indicator of disease severity, not imaging or initial serum enzyme levels.
A 45-year-old male with acute pancreatitis is showing signs of multisystem organ failure, including hypoxemia, hypotension, and renal insufficiency. The modified Marshall scoring system places a score of 2 for each of these systems. How should the severity of his condition be categorized?
A. Mild acute pancreatitis.
B. Severe acute pancreatitis with multisystem organ failure.
C. Moderate acute pancreatitis.
D. Acute pancreatitis with no significant systemic complications.
Correct Answer: B
Rationale: A score of 2 or more for two or more organ systems in the modified Marshall scoring system indicates severe acute pancreatitis with multisystem organ failure, which correlates with a poor prognosis.
What is the most critical clinical feature used to assess severity in the late phase of acute pancreatitis (>2 weeks)?
A. Serum amylase and lipase levels.
B. CT imaging findings of necrotizing pancreatitis.
C. The appearance of pleural effusion.
D. The development of biliary obstruction.
Correct Answer: B
Rationale: In the late phase, CT imaging is used to assess for complications like necrotizing pancreatitis, which can significantly affect the course of the disease and require intervention if infected.
Which of the following is true regarding moderately severe acute pancreatitis?
A) It is characterized by persistent organ failure for more than 48 hours.
B) Necrosis of the pancreas is present in all patients.
C) It may involve transient organ failure or local/systemic complications that resolve in less than 48 hours.
D) The condition typically resolves without the need for hospitalization.
Answer: C) It may involve transient organ failure or local/systemic complications that resolve in less than 48 hours.
Rationale:
Moderately severe acute pancreatitis involves transient organ failure (resolves within 48 hours) or local or systemic complications in the absence of persistent organ failure. This type of pancreatitis may require a prolonged hospitalization but typically has a low mortality rate.
Which of the following is the defining characteristic of mild acute pancreatitis?
A) Persistent organ failure lasting more than 48 hours
B) Transient organ failure that resolves in less than 48 hours
C) No local complications or organ failure, self-limited disease
D) Necrosis of the pancreas confirmed on imaging
Answer: C) No local complications or organ failure, self-limited disease
Rationale:
Mild acute pancreatitis is characterized by the absence of local complications or organ failure. It is self-limited and typically resolves within 3-7 days without the need for invasive interventions. Patients can resume oral intake once they have normal bowel function, are without nausea and vomiting, and feel hungry.
Which of the following is the most appropriate dietary recommendation for a patient recovering from mild acute pancreatitis?
A) A high-fat solid diet
B) A clear or full liquid diet initially, progressing to a low-fat solid diet once recovery is underway
C) Immediate solid foods with no dietary restrictions
D) Parenteral nutrition until the patient is symptom-free
Answer: B) A clear or full liquid diet initially, progressing to a low-fat solid diet once recovery is underway
Rationale:
For patients recovering from mild acute pancreatitis, it is common practice to start with a clear or full liquid diet and then transition to a low-fat solid diet once symptoms have subsided and bowel function has normalized. This gradual approach minimizes pancreatic stimulation during the recovery process.
In patients with severe acute pancreatitis, which of the following is the appropriate imaging technique to evaluate for complications or necrosis?
A) Abdominal X-ray
B) Abdominal ultrasound
C) CT scan or MRI
D) Endoscopic retrograde cholangiopancreatography (ERCP)
Answer: C) CT scan or MRI
Rationale:
In severe acute pancreatitis, a CT scan or MRI is recommended to assess for complications such as pancreatic necrosis or fluid collections. These imaging techniques provide high-resolution images to guide management decisions, including whether interventions are needed for local complications.
Which of the following is a characteristic feature of severe acute pancreatitis?
A) Self-limited with spontaneous resolution within 3-7 days
B) Persistent organ failure lasting more than 48 hours
C) Resolves without requiring imaging or hospitalization
D) No involvement of organ failure or complications
Answer: B) Persistent organ failure lasting more than 48 hours
Rationale:
Severe acute pancreatitis is defined by persistent organ failure (>48 hours) that involves one or more organs. It is a more serious form of the disease that requires intensive monitoring and may lead to complications such as necrosis, which is assessed using imaging like CT or MRI.
What is the most appropriate management for a patient with severe acute pancreatitis who has developed infected pancreatic necrosis?
A) Prophylactic antibiotics
B) Immediate surgery for pancreatic necrosis
C) Supportive care with no need for intervention
D) Percutaneous, endoscopic, or surgical intervention based on infection and clinical stability
Answer: D) Percutaneous, endoscopic, or surgical intervention based on infection and clinical stability
Rationale:
For severe acute pancreatitis with infected pancreatic necrosis, the approach includes supportive care along with intervention (percutaneous, endoscopic, or surgical) based on the patient’s clinical condition and the severity of the infection. Prophylactic antibiotics are not recommended for preventing infection in necrosis.
Which type of pancreatitis is characterized by diffuse gland enlargement, homogeneous contrast enhancement, and mild inflammatory changes or peripancreatic stranding on CT imaging?
A) Necrotizing pancreatitis
B) Interstitial pancreatitis
C) Chronic pancreatitis
D) Pancreatic cancer
Answer: B) Interstitial pancreatitis
Rationale:
Interstitial pancreatitis is the most common form of acute pancreatitis, occurring in 90-95% of cases. On CT imaging, it is characterized by diffuse gland enlargement, homogeneous contrast enhancement, and mild inflammatory changes or peripancreatic stranding. This type generally resolves with supportive care within a week.
In which scenario is CT imaging most beneficial for assessing local complications in acute pancreatitis?
A) Within the first 24 hours of admission in all patients
B) After 3–5 days of hospitalization if the patient is not responding to supportive care
C) For patients with mild pancreatitis to confirm diagnosis
D) Immediately after diagnosis of acute pancreatitis to identify severity
Answer: B) After 3–5 days of hospitalization if the patient is not responding to supportive care
Rationale:
CT imaging with IV contrast is best performed 3-5 days into hospitalization in patients not responding to supportive care. This allows time for the evolution of necrosis or other local complications, which are best evaluated after the initial inflammatory phase. Overutilization of CT within the first 72 hours is not recommended, particularly in mild cases.
Which of the following is characteristic of necrotizing pancreatitis as observed on CT imaging?
A) Diffuse gland enlargement and homogenous contrast enhancement
B) Lack of pancreatic parenchymal enhancement and/or peripancreatic necrosis
C) No inflammatory changes in peripancreatic areas
D) Only mild peripancreatic stranding without necrosis
Answer: B) Lack of pancreatic parenchymal enhancement and/or peripancreatic necrosis
Rationale:
Necrotizing pancreatitis is characterized by a lack of pancreatic parenchymal enhancement on contrast-enhanced CT, and the presence of peripancreatic necrosis. This is seen in 5-10% of acute pancreatitis cases and typically requires more careful monitoring due to its increased risk for complications and mortality.
Which factor is most predictive of increased mortality in necrotizing pancreatitis?
A) Presence of pancreatic necrosis with or without extrapancreatic necrosis
B) Presence of a single organ system failure
C) Mild inflammatory changes on imaging
D) Early initiation of supportive care
Answer: A) Presence of pancreatic necrosis with or without extrapancreatic necrosis
Rationale:
The presence of pancreatic necrosis, whether with or without extrapancreatic necrosis, is a significant factor for increased mortality in acute pancreatitis. Necrotizing pancreatitis is associated with high rates of organ failure, especially if the necrosis becomes infected, and the mortality rate can increase sharply with multiorgan failure.
those with only extrapancreatic necrosis have
a more favorable prognosis than patients with pancreatic necrosis
(with or without extrapancreatic necrosis).