Pancreatitis Flashcards
What are the characteristics of acute pancreatitis?
Acute pancreatitis is an acute inflammation of the pancreas. The degree of inflammation varies from mild oedema to severe hemorrhagic necrosis. The most common cause is gall-bladder disease (35%), followed by alcohol (25%).
What is the pathophysiology of pancreatitis?
The aetiological factors (alcohol, biliary tract disease, trauma, drugs, post-op GI surgery) injure pancreatic cells or activate pancreatic enzymes in the pancreas rather than in the intestine.
What are some of the signs and symptoms of pancreatitis?
LUQ/midepigastrium/back abdominal pain due to distension of the pancreas, peritoneal irritation and obstruction of the biliary tract.
Pain is usually described as severe, deep, piercing, continuous. Aggravated by lying flat, eating
Often accompanied by nausea and vomiting, low-grade fever, hypotension, tachycardia, jaundice, leucocytosis.
Grey turner’s spots- bluish/ecchymosis of the flanks
Cullen’s signs- a bluish peri-umbilical discolouration.
What are some of the complications of acute pancreatitis?
Pleural effusion, atelectasis, pneumonia, ARDS, hypotension, hypocalcaemia. Pseudocysts and abscess. A pseudocyst is an accumulation of fluid, pancreatic enzymes, tissue debris and inflammatory exudates surrounded by a wall. Symptoms include abdominal pain, palpable epigastric mass, n + v and anorexia. A pancreatic abscess is a collection of pus, which can become infected or perforate into adjacent organs. Symptoms include abdominal pain and mass, high fever and leukocytosis. Require prompt intervention to prevent sepsis.
What are the primary diagnostic tests for acute pancreatitis?
Serum amylase, serum lipase, urinary amylase, BGLs, and serum triglycerides will be elevated. Serum calcium will usually be low.
What are the treatment goals for pancreatitis?
Relief of pain; prevention or alleviation of shock; reduction of pancreatic secretions; correction of fluid and electrolyte imbalances; prevention or treatment of infections; remove precipitating cause if possible.
eg fluids, morphine, antispasmodics such as hyoscine, carbonic anhydrase inhibitor such as acetazolamide, antacids, proton pump inhibitors.
Which of the following symptoms would you antici pate observing with acute pancreatitis?
a) Elevated
white
blood
cell
count,
ankle
oedema
and
right
groin
pain
b) Left
upper
quadrant
abdominal
pain,
nausea,
and vomiting
c) Hypoglycaemia,
hypertension
and
hypochondrial
pain
d) Epigastric
pain,
pyrexia,
and
elevated
white
blood
cell
count
B
What are the signs and symptoms of hypocalcaemia, a complication of acute pancreatitis?
Jerking, irritability, muscular twitching, numbness/tingling of the lips
What is Human Immunodeficiency Virus Infection?
Infection caused by HIV, which is a retrovirus that causes immunosuppression. The viral infection causes the person to be susceptible to infections that would normally be controlled through immune response.
How is HIV transmitted?
Transmission of HIV occurs through: sexual intercourse with an infected partner; exposure to HIV-infected blood/ blood products; perinatal transmission during pregnancy, at delivery or through breastfeeding.
What variables influence whether HIV will be established after exposure?
- Duration and frequency of contact with the organism
- Volume, virulence and concentration of the organism
- Host immune status
What is the pathophysiology behind HIV?
HIV is an RNA virus, meaning they replicate backwards (RNA-DNA). Gp120 proteins on the viral envelope bind to specific CD4 and chemokine receptor sites on the cell’s surface. Once bound, viral RNA enters the CD4+ T cell, where it is transcribed into a single strand of viral DNA with the assistance of reverse transcriptase, an enzyme made by retroviruses. The strand copies itself, becoming double-stranded viral DNA, which then enters the cell’s nucleus and using the enzyme integrase, splices itself into the human genome, becoming a permanent part of the cell’s genetic structure. This action has two consequences: all daughter cells are infected and viral DNA in the genome directs the cell to make new HIV.
BLAH BLAH BLAH
What are the signs and symptoms of Acute HIV infection?
Flu like symptoms- fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhoea, rash etc for 1-3 weeks. Onset is 2-4w after infection. CD4+T cells fall temporarily but raise to baseline. The interval between untreated HIV infection and a diagnosis of AIDS is about 10 years.
What are the characteristics of symptomatic HIV infection?
As the CD4+T cell count drops to 200-500 cells/UL and the viral load increases, HIV advances to a more active stage. Persistent fever, frequent drenching night sweats, chronic diarrhoea, recurrent headaches and fatigue occur. Candidas organisms present, outbreaks of Kaposi’s sarcoma (malignant spots on the skin), herpes, bacterial infections etc
What is the criteria for AIDs as established by the CDC?
At least one of the following:
- CD4+T cell count drops below 200 cells/uL.
- One of the following infections: Fungal (Candidiasis, PCP), Viral (Cytomegalovirsus CMV diease, herpes simplex), protozoal (toxoplasmosis of the brain, chronic intestinal isoporiasis), Bacterial (TB, recurrent salmonella septicaemia).
- One of the following opportunistic cancers: KS, Burkitt’s/immunoblastic Lymphoma etc
- Wasting syndrome- 10% less that ideal body mass
- Aids dementia complex
