Pancreatitis

Question 1

What are the 4 main causes of acute pancreatitis?

Answer 1

Alcohol
Gallstones
Hypertriglyceridemia
Idiopathic

Question 2

A 65 yo female presents with acute upper abdominal pain. She indicates that it is in her RUQ and her back, and that position changes don’t help. She has N/V and hasn’t had anything to eat all day because eating makes everything worse. What do you suspect? What diagnostic tests should you order?

Answer 2

Acute pancreatitis
Gallstone:
ALT > 150
Lipase:Amylase > 2
MCV (low)
U/S - primary imaging

Question 3

A 55 yo male presents with upper abdominal pain, RUQ pain, back pain, N/V, fever, and tachycardia. He has a history of alcohol abuse. What do you suspect? What diagnostic tests should you perform?

Answer 3

Acute pancreatitis
Alcohol:
Total lipase (low)
MCV (high)

Question 4

A 55 yo male with a Hx of DM presents with RUQ abdominal pain that radiates to his back and isn’t relieved by leaning forward. On exam you note fever and tachycardia. What do you suspect and how would you diagnose it?

Answer 4

Acute pancreatitis
Hypertriglyceridemia:
Triglycerides > 1,000

Question 5

If a pt presents with signs of acute pancreatitis, what diagnostic imaging should you order?

Answer 5

U/S to visualize common bile duct
CT scan
ERCP if suspect cholangitis

Question 6

What finding would indicate organ failure when testing for acute pancreatitis?

Answer 6

HCT > 44

Question 7

How would you treat a pt with steady, mid-epigastric RUQ pain that radiates to the back?

Answer 7

NPO, "rest the pancreas"
Aggressive hydration (FLUIDS)
Treat obstruction, stop suspect medicines
Pain management!
Admit to hospital
Carefully monitor labs/imaging

Question 8

A pt presents with long-term variable abdominal pain. She mentions a 15 lb unintentional weight loss, diarrhea, polydipsia, and polyurea. 72 hour fecal fat is positive. What additional tests should you order?

Answer 8

Chronic pancreatitis
CT - duct dilation, cystic changes, calcification
ERCP - varying dilation, irregular pancreatic ducts
EUS w/ FNA - evaluation structure & biopsy

Question 9

A pt presents with long-term variable abdominal pain, weight loss, diarrhea, and signs and symptoms of diabetes. CT shows pancreatic duct dilation, cystic changes, and calcification. What treatment do you recommend?

Answer 9

Lifestyle changes - no EtOH, low fat diet, avoid exacerbating meds
Meds - analgesia
Oral pancreatic enzymes & acid suppression

Question 10

A pt presents with persistent chronic pancreatitis. How do you treat?

Answer 10

ERCP - dilate duct strictures

Surgery - pancreatojejunostomy, lateral pancreatojejunostomy

Question 11

A pt presents with severe, excruciating pain that slowly decreases. What do you suspect? What is the prognosis?

Answer 11

Pancreatic CA

Poor prognosis