Pancreatitis

Question 0

Phlagmon

Answer 0

Omental/ intestinal protection from inflammation. Felt as abdominal mass.
seen in Acute pancreatitis or Appendicitis.

Question 1

Protection from Acute pancreatitis

Answer 1

Low calcium level in pancreas
SPINK
SPTIs

Question 2

Signs of AP

Answer 2

Subcutaneous erythematous nodules
urtcher’s retinopathy (blinding caused by cytokines)
Callon’s
Grey turner

Question 3

Labs-AP

Answer 3

Leukocytosis
Hyperamylasimia/uria
Hyperglycemia
Hypocalcimia
Hypertriglyceridemia
Metabolic acidosis
Hyperkalemia

Question 4

Amylase test

Answer 4

Needs to be 3 times as much as normal. Takes 24hrs to rise.
It comes back normal in 5days.
Why normal?
-more than 5 days
-Chronic pancreatitis
-If there is hypertriglyceridemia is the cause (he doesnt know why)
Salivary gland lesions can also cause amylase increase.. so go for lipase!! Tripsins are more specific.

Question 5

Imaging

Answer 5

Plain x-ray classic signs

• Colon cut-off sign (dilated transverse and no ascending nor descending colon seen)
• Sentinel loop sign

CT (GOLD STANDARD)
CT guided needle aspiration (Tech of choice to know whether its infected or sterile)
-if infected-> surgery
-sterile-> medical tx
ERCP

Question 6

Ranson criteria

Answer 6

inneffective after 48hrs**

after 48hrs, use Apache II criteria or CT severity criteria

Question 7

Management of AP- mild

Answer 7

Ranson <7
Mild pain: acetaminophen
Moderate: 
Severe: meperidine
Bed rest
Feed the pts when they are hungry even tho the labs are still high

Question 8

Management of AP- severe

Answer 8

IV or Anteral feeding.

Treat sx accordingly.

Question 9

MC for AP in children

Answer 9

Seatbelt trauma

Question 10

Sx of CP

Answer 10

Alcoholic
Weight loss
DM
Jaundice
Steatolia

Question 11

Dx of CP

Answer 11

Plain x-ray
-Calcification btw L1-L2
ERCP
-Chain of lakes or string of pearls

Question 12

Labs of CP

Answer 12

Secretin and CCK level is very LOW**

Question 13

Tx of CP

Answer 13

Pancreatic enzyme replacement
Management of pain
Control diet
manage DM

Question 14

Carcinoma of Pancreas

Answer 14

MC- adenocarcinoma
MCS- head of pancreas
Risk- smoking, CP

Question 15

classical signs of carcinoma

Answer 15

Varchows node
sister marry joseph sign-periumbilical
Couversior’s sign- painless palpable GB in elderly woman with severe jaundice**
Troussour’s syndrome- migratory thrombophlebitis**

Question 16

Imaging- Carcinoma

Answer 16

Cholangiography

Question 17

Tx- carcinoma

Answer 17

Tail- cut off

Head- cut off the entire area

Question 18

CT scan severity index- acute pancreatitis

Answer 18

0- Normal
1- Edema
2- Edema+peripancreatic tissue
3- 2+ ONE fluid collection
4- 3+ MULTIPLE fluid collection

0- No necrosis
2- >30% necrosis
4- 30-50% necrosis
6- >50% necrosis

<7 points: mild case of acute pancreatits

Question 19

Ranson Score

Answer 19

> 3: Severe acute pancreatitis