Pancreatitis

Question 1

Inflammatory condition of the pancreas characterized by the sudden onset and involvement of other organs

Answer 1

Acute pancreatitis

Question 2

_____ persons per 100,000 person per year have pancreatitis

Answer 2

19.5

Question 3

Approximately _____ cases/year, with 20-30% of those being severe

Answer 3

800,000

Question 4

Frequency (increase / decreases) with age

Answer 4

Increases

Question 5

Acute pancreatitis is more common in which race?

Answer 5

African Americans

Question 6

Alcoholism accounts for _____ of cases, and are usually male patients

Answer 6

65%

Question 7

Gallstones account for _____ of cases, but is the usual cause for females

Answer 7

10%

Question 8

Other causes of acute pancreatitis include which factors? (5)

Answer 8

1. Genetics
2. Surgery or Trauma
3. Congenital abnormality
4. Cystic fibrosis
5. Medications

Question 9

Pancreas has two main parts known as

Answer 9

Exocrine and endocrine

Question 10

What is the exocrine system responsible for?

Answer 10

Secrete digestive enzymes to break down food

Question 11

What is the endocrine system responsible for?

Answer 11

Insulin and glucagon regulate glucose

Question 12

The pancreas is made up of mostly which tissue?

Answer 12

Exocrine tissue arranged in clusters connected via a series of ducts

Question 13

How does the pancreas go about its main action of helping to digest food?

Answer 13

Digestive juices and enzymes collect in ducts and mix with food in duodenum

Question 14

How does alcohol contribute to the initiation of pancreatic inflammation?

Answer 14

Affect the sphincter of Oddi, causing it to spasm which prematurely releases enzymes and increases duct permeability

Question 15

How do gallstones contribute to the initiation of pancreatic inflammation?

Answer 15

Causes a direct physical obstruction or overdistention of the ducts

Question 16

What are the 5 steps of pancreatic pathophysiology

Answer 16

1. Initiation of pancreatic inflammation
2. Premature activation of digestive enzymes
3. Leakage of pancreatic enzymes
4. Autodigestion, inflammation, cell death (pancreatic necrosis)
5. Mild, localized damage or severe necrosis (not able to produce exocrine or endocrine functions)

Question 17

What is the issue with repeated acute episodes of pancreatitis?

Answer 17

Inflammation is usually able to resolve itself, but when it is repeated, the damage can result in the forming excessive fibrin and scar tissue (fibrosis)

Question 18

Clinical presentation of pancreatitis includes what symptoms? (5)

Answer 18

1. Upper abdominal/left upper quadrant pain - sudden onset, unremitting, gradually worsening
2. Pain may improve by sitting or leaning forward
3. Nausea and vomiting
4. Tender, distended abdomen with decreased BS
5. Fever, tachycardia, tachypnea, hypotension, pallor, clammy skin

Question 19

What values can increase by up to 3-fold, with one specific value being most specific to pancreatitis?

Answer 19

Serum amylase and lipase; lipase most specific

Question 20

What happens to WBC values?

Answer 20

Increase

Question 21

What happens to glucose levels?

Answer 21

Increase (hyperglycemia)

Question 22

What levels may increase if damage extends to the liver?

Answer 22

Elevated bilirubin and liver enzymes (AST)

Question 23

What is the staging method used for diagnosing severity of acute pancreatitis?

Answer 23

CT-determined grade (A is best, E is worst)

Question 24

What are more severe complications that can arise from acute pancreatitis? (4)

Answer 24

1. Hypovolemic or septic shock
2. Acute renal failure
3. Pancreatic necrosis
4. Multisystem organ failure

Question 25

Overall mortality is ___ - ___%, but higher if it presents as ____ etiology due to gallstones

Answer 25

10-15%; bilary etiology

Question 26

Long-term mortality is mostly due to ____ from untreated recurrent pancreatitis

Answer 26

infection

Question 27

Age and mortality have what relationship with acute pancreatitis?

Answer 27

Direct relationship