Pancreatitis Flashcards
What is acute pancreatitis?
Inflammation of the pancreas
What are the most common etiologies of acute pancreatitis in the US?
Alcohol abuse (50%)
Gallstones (30%)
Idiopathic (10%)
Acronym for causes of pancreatitis?
I GET SMASHED
Idiopathic
Gallstones Ethanol Trauma
Scorpion bite Mumps Autoimmune Steroids Hyperlipidemia ERCP Drugs
Sx of pancreatitis?
Epigastric pain (frequently radiates to back)
Nausea/Vomiting
What are the signs of pancreatitis?
Epigastric tenderness
Diffuse abdominal tenderness
Decreased bowel sounds (adynamic ileus)
Fever
Dehydration/shock
What is the DDx for pancreatitis?
Gastritis/PUD
Perforated viscus
Acute cholecystitis
SBO
Mesenteric ischemia/infarction
Ruptured AAA
Biliary colic
Inferior MI/pneumonia
What labs should be ordered if suspected pancreatitis?
CBC
LFT
Amylase/Lipase
Type/cross
ABG
Calcium
Chemistry
Coags
Serum lipids
What are the associated lab findings with pancreatitis?
Labs: High amylase/lipase, high WBC
AXR: Sentinel loop, colon cutoff, possibly gallstones (10% visible on xray)
U/S: Phelgmon, cholelithiasis
CT: Phlegmon, pancreatic necrosis
What is the most common sign of pancreatitis on AXR?
Sentinel loops
What is the treatment for pancreatitis?
NPO
IVF
NGT if vomiting
H2 blockers/PPI
Analgesia (Demerol)
Correction of coags/electrolytes
Alcohol prophylaxis
“tincture of time”
What are the possible complications of pancreatitis?
Pseudocyst
Abscess/infection
pancreatic necrosis
splenic/mesenteric/portal vessel rupture of thrombosis
pancreatic ascites/pancreatic pleural effusion
DM
ARDS/sepsis/MOF
Coagulopathy/DIC
Encephalopathy
Severe hypocalcemia
What is the prognosis of pancreatitis?
Based on Ranson’s criteria
What is the Ranson’s criteria for the initial 48 hours?
- Base deficit >4
- BUN increase > 5mg/dL
- Fluid sequestration >6L
- Serum Ca <8
- Hct decrease >10%
- PO2 (ABG) <60mmHg
What is Ranson’s criteria at presentation of pancreatitis?
- Age >55
- WBC > 16,000
- Glucose > 200
- AST > 250
- LDH >350
Are postpyloric tube feeds safe in acute pancreatitis?
Yes!
What are the mortality rates for positive Ranson’s criteria?
0-2: <5%
3-4: ~15%
5-6: ~40%
7-8: ~100%
Why does hypocalcemia occur in pancreatitis?
fat saponifications: fat necrosis binds to calcium
What complication is associated with splenic vein thrombosis?
Gastric varices
(treat with splenectomy)
Can TPN with lipids be given to a patient with pancreatitis?
Yes if the patient doesn’t suffer from hyperlipidemia
(triglycerides <300)
What is the least common cause of acute pancreatitis (MOST commonly asked on rounds)?
Scorpion bite
What is chronic pancreatitis?
Chronic inflammation of the pancreas region causing destruction of parenchyma, fibrosis, and calcification, resulting in loss of endocrine and exocrine tissue
What are the two subtypes of chronic pancreatitis?
Chronic calcific pancreatitis
Chronic obstructive pancreaitis (5%)
Causes of chronic pancreatitis?
Alcohol abuse (MC-70%)
Idiopathic (15%)
Hypercalcemia (Hyperparathyroidism)
Hyperlipidemia
Familial
Trauma
Iatrogenic
Gallstones
What are the sx of chronic pancreatitis?
Epigastric and/or back pain
Weight loss
Steatorrhea
What are associated signs with chronic pancreatitis?
Type 1 DM (up to 1/3)
Steatorrhea (up to 1/4)
Weight loss
What are the signs of pancreatic exocine insufficiency?
Steatorrhea (fat malabsorption from lipase insufficiency-stools will float in water)
Malnutrition
What are the signs of pancreatic endocrine insufficiency?
Diabetes (glucose intolerance)
What are the common pain patterns with chronic pancreatitis?
Unrelenting pain
Recurrent pain
What is the DDx with pancreatitis?
PUD
Biliary tract disease
AAA
Pancreatic cancer
Angina
What % of patients with chronic pancreatitis have or will develop pancreatic cancer?
2%
