Pancreatitis Flashcards
What is the etiology of 70 percent of pancreatitis?
ETOH - Ethanol. But don’t assume just bc patient is drinking that the cause is alcohol, could still be gallstones, etc.
What is the second most common cause of pancreatitis?
Cholelithiasis - Stones lodge in the pancreatic duct or ampulla of Vater and cause an obstruction and subsequent extravasation of enzymes into the parenchyma
What are another “other cause” of pancreatitis?
Elevated triglycerides - greater than 1000 mg/dL
In pancreatitis pathophysiology, what is acute edematous pancreatitis?
Parenchymal edema and peripancreatic fat necrosis occurs first in disease progression.
In pancreatitis pathophysiology, what is hemorrhagic or necrotizing pancreatitis?
When necrosis involves the parenchyma along with hemorrhage and gland dysfunction it is described as hemorrhagic or necrotizing. (late stage)
What are symptoms of Pancreatitis?
- Mid-epigastric pain (95 percent)
- Severe
- Moderately rapid onset (about 30 minutes)
- Progressive and constant
- Can radiate to the back (50 percent)
- Nausea/Vomiting (60-80 percent)
How do patients with Pancreatitis appear on exam?
Appear ill, holding abdomen and likely to be moving around - unable to get comfortable.
Tender epigastrium
What is Gray Turner sign and Cullen’s sign? Are they common?
Gray Turner - bruising of flank
Cullen’s - edema and bruising of fat tissue below belly button
Uncommon but classically described findings with severe hemorrhagic pancreatitis caused by leaking retroperitoneal blood.
What is the more sensitive and specific than amylase for a Pancreatic lab test?
LIPASE
What are the lab findings in Pancreatitis?
-Increased Amylase/Lipase -Increased WBC -Increased glucose -Dehydration -LDH and AST Inc. -Ca2 Dec -O2 Dec -Albumin Dec CRP greater than 15 mg/dl 48 hrs after symptom onset indicates indicated severity
What is the value of Ranson’s Criteria?
Predict mortality after 48 hours of acquired information. You must wait to get the information at 48 hours. The criteria are not used to predict mortality at admission with only initial labs
What imaging modality is commonly used for Pancreatitis?
CT abdominal - 85-95 percent accuracy for detection of necrosis
What is a Sentinel Loop?
Although not commonly present is classic for pancreatitis on Xray - A sentinel loop is a dilated loop of small bowel field with air near the pancreas
What is the initial treatment for Pancreatitis?
IV hydration, NPO (nothing oral), Pain control, removal of stones
What is the typical course of Pancreatitis?
Typically improves in 3-7 days
-Decreased pain and lipase levels, improved vital signs
