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GI/Hepatic Final > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What drugs affect the pancreas?

A

Cipro
APAP
Meropenem
Opioids

Somatostatin
Tramadol
Octreotide
Metronidazole
Pancreatic enzymes
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2
Q

What drugs have endocrine functions?

A

Insulin (beta-cells)
Glucagon (alpha-cells)
Somatostatin

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3
Q

What drugs have exocrine function?

A

Secretion of isotonic fluid
Bicarbonate (to neutralize acid)
Pancreatic enzymes to neutralize food)

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4
Q

Pancreatic enzymes?

A 
Proteolytic
Amylolytic
Lipolytic
Nucleolytic
Miscellaneous
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5
Q

Pancreatic enzymes: proteolytic

A

Trypsinogen

Chymotrypsinogen

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6
Q

Pancreatic enzymes: Amylolytic

A

Amylase

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7
Q

Pancreatic enzymes: Lipolytic

A

Lipase
Phospholipase A2
Carboxylesterase lipase

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8
Q

Pancreatic enzymes: Nucleolytic

A

Ribonuclease

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9
Q

Pancreatic enzymes: miscellaneous

A

Trypsin inhibitor

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10
Q

Normal sequence of events for pancreatic stimulation

A

Cephalic (when you are hungry)
Gastric (starts to ramp up and pump out fluid)
Intestinal

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11
Q

What enzymes are secreted in the intestine?

A

Secretin

Cholecystokinin

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12
Q

Where are zymogens activated?

A

Duodenum

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13
Q

What enzyme activates other enzymes?

A

Trypsin

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14
Q

What is the primary cause of acute pancreatitis?

A

Gall stones

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15
Q

What toxins cause acute pancreatitis?

A

Alcohol

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16
Q

What are the causes of acute pancreatitis?

A 
Structural
Toxins
Infectious
Metabolic
Medication
Trauma
Vascular
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17
Q

Metabolic causes of acute pancreatitis?

A

Genetic hypertriglyceridemia

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18
Q

What medications can cause acute pancreatitics

A

Valproic acid
GLP-1 agonists
Sulfonamides
DPP4 inhibitors

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19
Q

What clinical presentations is in 100% of patients with acute pancreatitis?

A

Abdominal pain

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20
Q

What are the clinical presentations of acute pancreatitis?

A

Ab pain
Nausea +/- vomiting
Ab distention
Fever
Hypotension
Pancreatic inflammation and/or necrosis, increased CRP
Leukocytosis, hyperglycemia, hypoalbuminemia, hyperbilirubinemia
Elevated alkaline phosphatase and liver transaminases
Dehydration
Hypocalcemia

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21
Q

What are the options for imaging for acute pancreatitis?

A 
Ab Xray
Ab ultrasound
CT
ERCP
EUS
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22
Q

How is acute pancreatitis diagnosed?

A

Characteristic ab pain
Serum amylase and/or lipase >/= 3 times ULN
Imaging if needed

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23
Q

What are the principles for the severity and risk prediction of mild acute pancreatitis?

A

No organ failure

No complications

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24
Q

What are the principles for the severity and risk prediction of moderately severe acute pancreatitis?

A

Local complications AND/OR transient organ failure

25
Q

What are the principles for the severity and risk prediction of severe acute pancreatitis?

A

Persistent organ failure

26
Q

What are the complications of acute pancreatitis?

A 
Pancreatic ascites
Pseudocyst
Abscess
Necrosis
Systemic complications
27
Q

What are pancreatic ascites?

A

Pancreatic secretions spread throughout peritoneal cavity

28
Q

What are pseudocysts?

A

Collecting of pancreatic juice enclosed by a wall of fibrous tissue

29
Q

What causes pseudocysts?

A

Pancreatic juice persistently leaking from the pancreatic duct

30
Q

What causes pancreatic ascites?

A

Increased permeability d/t inflammation

31
Q

What causes abscesses in acute pancreatitis?

A

Follows infection of pancreatic or peripancreatic necrosis

32
Q

What defines necrosis in acute pancreatitis?

A

Presence of 1+ diffuse or focal areas of nonviable pancreatic parenchyma may be sterile or infected

33
Q

What are systemic complications of acute pancreatitis?

A

CV, renal, pulmonary

34
Q

What are the causes of systemic complications in acute pancreatitis?

A

Hypovolemia

Hypotension

35
Q

What are the supportive care treatments for ALL patients with acute pancreatitis?

A

Fluid resuscitation
Nutrition
Pain control
Antiemetics

36
Q

What is used in fluid resuscitation of acute pancreatitis?

A

Lactated ringers or NS

Correct intra-vascular volume depletion

37
Q

What is nutrition used for in acute pancreatitis?

A

Enteral over parenteral

Beginning within 48 hours shows benefit

38
Q

How is pain controlled in pancreatitis?

A

IV/PCA
Continued until able to tolerate PO
Morphine (not in AKI), Dilaudid, fentanyl

39
Q

What are additional cares for moderately severe and severe acute pancreatitis?

A

Supportive care for end organ damage
Surgical care for local complications, if minimal/no improvement
Judicious use of abx and antisecretory agents, as appropriate

40
Q

What abx are used in acute pancreatitis?

A

Ceph
Quinalones + Flagyl
Carbapenems

41
Q

Why are abx used in acute pancreatitis?

A

May decrease complications in necrotic pancreatitis
Prophylactic abx not warranted
Spectrum should include GI pathogens

42
Q

What antisecretory agents are used in acute pancreatitis?

A

Octreotide

Somatostatin

43
Q

What is the use of antisecretory agents in acute pancreatitis?

A

May inhibit pancreatic secretions
Insufficient data to support use in all patients
Routine use not in guidelines

44
Q

What is the pathophysiology of acute pancreatitis?

A

Inflammation that leads to cellular necrosis and fibrosis
Protein plug formation that blocks interlobular and intralobular ducts
Progressive structural damage in ducts and tissues

45
Q

What is the cause of the formation of a protein plug?

A

D/t high protein, low bicarbonate secretion

46
Q

What is the clinical presentation of chronic pancreatitis?

A

Chronic ab pain (typically post prandial and associated with N/V)
Recurrent episodes of acute pancreatitis
Exocrine malfunction
Endocrine malfunction

47
Q

What are the results of exocrine malfunction?

A

Steatorrhea
Malabsorption
Vitamin deficiency (ADEK, B12)

48
Q

What are the results of endocrine malfunction?

A

Diabetes

49
Q

How do we diagnose chronic pancreatitis?

A

Amylase and lipase are nonspecific for chronic pancreatitis
Ab CT/MRCP are sensitive but not specific for diagnosis
Fecal fat and fecal elastase 1 concentrations may be helpful

50
Q

What are ways to manage pain in chronic pancreatitis?

A

Lifestyle modifications

51
Q

What are the lifestyle modifications for chronic pancreatitis pain management?

A

Alcohol and smoking cessation correlate with a reduction in pain
Smaller meals, low-fat diet or elemental diets reduce pain and enzyme secretion

52
Q

What are the options for chronic pancreatitis analgesia?

A 
Antioxidants
APAP
NSAIDs
Adjunct therapies
Opioids
53
Q

How are antioxidants used in chronic pancreatitis pain management?

A

Might be efficacious if used in combination with lifestyle medications

54
Q

What concerns are there for APAP in chronic pancreatitis pain management?

A

With continued alcohol risk

55
Q

What concerns are there for NSAIDs in chronic pancreatitis pain management?

A

Risk for GI bleeding

56
Q

Which adjunct therapies in chronic pancreatitis pain management shows the most promise?

A

Pregabalin

57
Q

What concerns are there for opioids in chronic pancreatitis pain management?

A

Development of dependence and tolerability. Opioid related ADR

58
Q

How should pancreatic enzyme replacement therapy tablets be taken?

A

Give with acid suppression agent to increase efficacy

Take with food

59
Q

How should pancreatic enzyme replacement therapy enteric coated be taken?

A

Microspheres can be administered with tube feedings

GI/Hepatic Final (6 decks)

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