Pancreatitis

Question 1

def. panctreatitis 2 types

Answer 1

acute - infammation with no perm. injury

chronic - fibrosis, scarring, destruction

Question 2

2 types of panc. functions

Answer 2

exocrine - digestive zymogens

endocrine - insulin, glucagon

Question 3

patho in acute panc.

Answer 3

sudden panc. injury

• release of enzymes
• most mild/moderate

Question 4

** 2 major causes and 4 minor causes

Answer 4

major - alc. and gallstones

minor - drugs, infection, hyperlipid, trauma

Question 5

5 misc. causes if AP

Answer 5

1. post-ERCP
2. cardiac surg
3. struct. abnormalility
4. CF
5. hereditary

Question 6

how does gene/env change with age

Answer 6

more env. causes as we age

Question 7

2 mech. of drug induced AP

Answer 7

1. immunologically realted
   - rash, eosiniphilia
   - fast onset
2. chronic accumulation of toxic meatobolitess
   - can be slow to dev.

Question 8

reccemnedations for CF testing

Answer 8

1. ion channel testing is main test

- not reccomend gene sequencing

Question 9

4 local effects of enzyme release

Answer 9

1. inflmmation
2. third space losses
3. fat necrosis
4. pancreatic and peripancreatic necrosis

Question 10

5 systemic effects of pancreatitis

Answer 10

1. WBC chemotaxis
2. DIC
3. vessel attacks
4. cell membrane destructiom
5. fat necerosis

Question 11

clin. presentation of AP

Answer 11

abdo pain

• epigastric
• radiation to back 1/3
• worse with food
• assoc. with nausea/vomiting

Question 12

PE of AP

Answer 12

• tachymnea/cardia, hypotension
• icterus
• abdo dist.
• cullen, turner signs
• dullness at lung bases
• rebound tenderness

Question 13

what are 2 serum markers and which is better

Answer 13

lipase - more specific and sens
amylase
- use lipase

Question 14

2 major prognositic factors

Answer 14

1. organ failure
2. local complications
   - necrosis
   - abscess
   - pseudocyst

Question 15

3 levels of severity

Answer 15

self-limited: 75-85%
severe course - 15-25%
overall mort. : 3-5%

Question 16

best predictors of severity (2)

Answer 16

1. close obs
2. good clinical judgement
   - higher rates for BMI>29

Question 17

treatment in AP (5)

Answer 17

no change in decades

• treat like burn
• fluids
• resp
• renal
• nutrition
• pain releif

Question 18

7 possible complications of AP

Answer 18

1. panc. necrosis
   - sterile or infected
2. pancreatic pseudocyst
   - can drain if large
3. hemmoragic
   - cullen/grey turner
4. adult resp. distress syndrome
5. panc. ascites/pleural effusion
6. ascending cholangitis
   - leads to infection of biliary tract
7. panc. abscess

Question 19

causes of chronic panc (CP)

Answer 19

alc. 80%

Question 20

Sx of CP

Answer 20

same as acute

Question 21

Dx of CP

Answer 21

1. CT
2. xray can find calcifications, but only in 30%
3. ERCP - gold standard but invasive
4. lab studies not helpful

Question 22

9 complications of CP

Answer 22

1. narc. addictions
2. DM/imparied glucose tolerance
3. malabsorbtion/stehatorea
4. pseudocyts
5. abscess
6. B12 def.
7. panc. ductal dilatation
8. effusions
   9panc. carcinoma

Question 23

2 Tx

Answer 23

1. supportive
   - NPO
   - analgesics
   - insulin
   - alc. abstinece
2. surgery