Pancreatitis

Question 1

Most pancreatitis cases are due to

Answer 1

gallstone and chronic alcohol abuse

Question 2

Fxn pancreas

Answer 2

breaks down carbs, proteins, lipids

Question 3

Acute pancreatitis

Answer 3

occurs suddenly and may result in life-threatening complications

Question 4

Recurrent pancreatitis

Answer 4

25% will have recurrence; most due to alcohol or cholelithiasis

Question 5

Cause of acute pancreatitis

Answer 5

Gallstone
alcohol
idiopathic
Post-ERCP
HyperTG
Hypercalcemia
Smoking
Drugs
Infection
Trauma

Question 6

Complication acute pancreatitis

Answer 6

• multisystem organ failure- renal failure, acute respiratory distress syndromes, cardiac dysfunction
• intravascular depletion
  ileus
  pancreatic pseudocyst
  pancreatic necrosis

Question 7

Clinical acute pancreatitis

Answer 7

Midepigastric pain- patient lays forward and worst when laying back
pain radiates to back
N/V
dyspnea
epigastric tenderness
jaundice

Question 8

Severe sx of acute pancreatitis

Answer 8

tachypnea
hypoxemia
hypotension
ARDS
cullen's sign
Grey turner syndrome

Question 9

Cullen sign

Answer 9

• exomotic discoloration in periumbilical region due to bleeding intrabdominal
• most likely have necrotizing pancreatitis

Question 10

Grey Turner sign

Answer 10

• exomatic discoloration along flanks due to hemorrhage

- most likely have necrotizing pancreatitis

Question 11

Labs acute pancreatitis

Answer 11

Amylase 3xULN
Lipase 3xULN
CBC with diff- HCT increase
BMP- BUN/creatine elevated, hyperglycemia
LFT- hyperbilirubinemia, increase ALT+AST, direct bilirubin will be higher
LDH
C-reactive protein
Fasting TG over 1000

Question 12

Imaging acute pancreatitis

Answer 12

CT abdomen with IV contrast
abdominal US
MRI

Question 13

Essentials for Dx acute pancreatitis

Answer 13

2 of the following:
midepigastric pain +/- radiation into the back
lipase and/or amylase 3xULN
CT confirmation of pancreatitis

Question 14

Tx Acute pancreatitis

Answer 14

Admit to hospital 
Predictor score
Determine cause
NPO, IVF with lactated ringers
Parental analgesic, antiemetic
Rpt labs BUN/creatinine, HCT every 8-12hrs
Serial exams for fluid overload
clear fluids--> low fat diet

Question 15

Predictors of acute pancreatitis

Answer 15

Banson criteria
APACHE 2 Score
SIRS Score
BISAP

Question 16

SIRS Criteria

Answer 16

2 of the following
- temperature over 38.3 or less than 36
- HR over 90
RR over 20
WBC over 12,000

Question 17

Chronic pancreatitis

Answer 17

• irreversible damage to the pancreas as distinct from the reversible changes noted in acute pancreatitis

Question 18

Histology of chronic pancreatitis

Answer 18

chronic inflammation, fibrosis, progressive destruction of exocrine and endocrine tissue

Question 19

Cause chronic pancreatitis

Answer 19

alcohol abuse
idiopathic
cigarette
cystic fibrosis (children)
genetic
autoimmune pancreatitis

Question 20

chronic pancreatitis complications

Answer 20

narcotic addiction
DM
gastroparesis
malabsorption
biliary stricture
pancreatic carcinoma
hereditary pancreatitis

Question 21

Clinical chronic pancreatitis

Answer 21

abdominal pain
anorexia
maldigestion
weight loss
N/V
steatorrhea
tenderness over pancreas during attacks

Question 22

Dx chronic pancreatitis

Answer 22

Amylase and lipase- mild to normal
Glucose elevated
Secretin test-abnormal if >60% of pancreatic exocrine fxn lost
Abdominal CT (initial)

Question 23

Tx chronic pancreatitis

Answer 23

• low fat diet, refrain from alcohol
• steatorrhea: PDA approved pancreatic enzyme
• Endoscopic tx: sphincterotomy, stenting, stone extraction, drainage of pseudocyst
• Whipple, total pancreatectomy, autologous islet cell transplantation