Pancreatitis

Question 1

What are the two types of pancreatitis?

Answer 1

acute

chronic

Question 2

What is the most common cause of pancreatitis?

Answer 2

alcohol - 70%

Question 3

How can alcohol cause pancreatitis?

Answer 3

It causes intracellular accumulation of digestive enzymes and premature release/activation

also increases the permeability of the ductules, so you get those enzymes into the parenchyma

dauses autodigestion of the pancreas

Question 4

What is the obstructive cause of pancreatitis?

Answer 4

cholelithiasis that lodge int he pancreatic duct or ampulla of vater

leads to backward buildup of enzymes that then leak into the parenchym

Question 5

There are tons of other causes, but what are two more common?

Answer 5

elevated tiglycerides over 1000

meds

Question 6

Why does inflammation spread so easily from pancreatitis?

Answer 6

it’s retroperitoneal so there’s not much to stop it

Question 7

What enzyme starts the autodigestion and what contribute afterwards?

Answer 7

trypsin starts it

Phospholipase A, elastase, lipase and chymotrypsin contrinue it

Question 8

What will happen pathologically first? THen what’s th eprogression? WHat’s the worst thing that can happen?

Answer 8

parenchymal edema and peripancreatic fat necrosis occurs first

this can progress to necrosis involving the parenchyma = this is the worst = hemorrhagic or necrotixing pancreatitis

Question 9

What are the symptosm of acute pancreatitis?

Answer 9

mid-epigastric pain = often severe with moderately rapid onset. it’s progressive and constant. can radiate to the back.

some people have nausea and vomiting

Question 10

What will the patient with acute pancreatitis look like?

Answer 10

will appear very ill - holding abdomen and likely moving around (unable to get comfortable)

Question 11

WHat will you see on exam in acute pancreatitis?

Answer 11

tender epigastrum
pleural effusion
fever
decreased BP, increased HR and RR

Gray TUrner and Cullen’s sign

Question 12

WHat is Gray TUrner sign? What is Cullen’s sign?

Answer 12

Gray turner = fank ecchymosis
Cullen = periumbilical ecchymosis

It’s from severe hemorrhagic pancreatitis caused by leaking retroperitoenal blood

Question 13

What’s the main lab test for looking at acute pancreatitis? What one isn’t all that helpfil?

Answer 13

lipase is best

amylase doesn’t really do much

Question 14

What are some other lab findings you might see in acute pancreatitis?

Answer 14

high WBC, increased glucose, dehydration, high bilirubein, LDH and AST. Low calcium. low albumin, low O2 (can lead to an ARDS presentation), CRP can be elevated - this is a bad sign

urinary trypsinogen 2 maybe in the future

Question 15

What criteria are used to predict mortality?

Answer 15

Ranson’s criteria - the higher number increases mortality risk (after 48 hours)

Question 16

What imaging has 85-985% accuracy for detection of necrosis?

Answer 16

CT abdomen

Question 17

What will you see surrounding the pancreas on CT in pancreatitis?

Answer 17

a dark ring around it - edema

Question 18

What is the nonspecific and unsensitive sign for pancreatitis on abdominal x0ray?

Answer 18

a sentinel loop

it’s a dialted loop of small bowel filled with air near the pancreas

Question 19

How do they look for pancreatitis in Europe?

Answer 19

periteonal tap

Question 20

What is the treatment for acute pancreatitis?

Answer 20

IV hydration
nothing per mouth
pain control with narcotics
O2 is sats drop
NG tube only if necessary with N/V
Usually no antibiotics but maybe in severe cases if evidence of infection

Question 21

Describe the typical course for acute pancreatitis?

Answer 21

it typically improves in 3-7 days - you’ll have decreased pain and lipase levels with improved vital signs

Question 22

What percentage of people with the necrotic form will die?

Answer 22

15%

Question 23

What can occur in the pancreas after pancreatitis?

Answer 23

development of a pseudocyts which is just enzymes being walled off by granulation tissue in necrotizing pancreatitis

Question 24

What are the three general types of chronic pncreatitis?

Answer 24

1. chronic calcifying pancreatitis
2. chronic obstructive pancreatitis
3. Tropical pancreatitis

Question 25

What are the 5 major causes of chronic pancreatitis?

Answer 25

ETOH
hypertriglyderidemia
obstructive
autoimmune
trauma

Question 26

How do the labs in chronic pancreatitis differ from those in acute?

Answer 26

lipase and amylase may often be normal or only slightly elevated in chronic

Question 27

What are some signs and symptoms of chronic pancreatitis?

Answer 27

dull epigastric pain radiating to back

diarrhea with bulky, loose, smelly pale clay-colored stools, weight loss, hyperglycemia,

Question 28

What are the management steps for chronic pancreatitis?

Answer 28

enzyme therapy for malabsorption

reducing fat intake

eat medium chain triglyderides which are more easily digested and absorbed

Question 29

What are hte potential complications of chronic pancreatitis?

Answer 29

ascited, pancreatic pseudocyst, diabetes, malabsorption, and vitamin malabsorption (ADEK)

Question 30

Why is pancreatic cancer prognosis so dismal (5 yr survival rate 5%)?

Answer 30

it’s usually not diagnosed until late

Question 31

WHat are the nonspecific symptoms pf pancreatic cancer?

Answer 31

weight loss
visceral abdominal pain
jaundice

Question 32

What are hte risk factors for pancreatic cancer?

Answer 32

history of chronic pancreatitis
diabetes mellitus
smoking