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GASTROENTEROLOGY > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Main stimulator of secretion of water and electrolytes from the pancreatic ductal cells

A

Secretin (lesser extent, CCK)

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2
Q

Evokes an enzyme-rich secretion from pancreatic acinar cells

A

CCK

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3
Q

5 causes of acute pancreatitis

A

Gallstone, alcohol, ERCP, hypertriglyceridemia, drugs

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4
Q

Type of pancreatitis where pancreas blood supply is maintained

A

Interstitial pancreatitis

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5
Q

Type of pancreatitis where pancreas blood supply is interrupted

A

Necrotizing pancreatitis

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6
Q

Accepted pathogenic theory of acute pancreatitis where proteolytic enzymes are activated in the pancreas acinar cell rather than in the intestinal lumen due to premature activation of trypsin

A

Autodigestion

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7
Q

Major symptom of acute pancreatitis

A

Abdominal pain

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8
Q

Characteristic of abdominal pain in acute pancreatitis

A

Steady and boring in the epigastrium or periumbilical region, and may radiate to the back, chest, flanks, and lower abdomen

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9
Q

3 causes of shock in acute pancreatitis

A

o Hypovolemia
o Increased kinin peptides – causing vasodilation
o Systemic effects of proteolytic and lipolytic enzymes

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10
Q

Part of pancreas that is edematous when there is occurrence of jaundice

A

Head of the pancreas

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11
Q

Location of pleural effusion in acute pancreatitis

A

Left-sided

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12
Q

Faint blue discoloration around the umbilicus

A

Cullen’s sign

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13
Q

Cause of cullen’s sign

A

Hemoperitoneum

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14
Q

Blue-red-purple or green-brown discoloration of the flanks

A

Turner’s sign

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15
Q

Cause of Turner’s sign

A

Due to tissue catabolism of hemoglobin from severe necrotizing pancreatitis with hemorrhage

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16
Q

Serum amylase in acute pancreatitis returns to normal in how many days:

A

3-7 days

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17
Q

Serum lipase in acute pancreatitis returns to normal in how many days

A

7-14 days

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18
Q

Preferred test for acute pancreatitis

A

Lipase

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19
Q

More specific test for acute pancreatitis

A

Lipase

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20
Q

Harbinger of more severe disease (i.e. pancreatic necrosis) in acute pancreatitis

A

Hemoconcentration (Hct > 44%)

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21
Q

Cause of prerenal azotemia in acute pancreatitis

A

Due to loss of plasma intro the retroperitoneal space and peritoneal cavity

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22
Q

3 causes of hyperglycemia in acute pancreatitis:

A

o Decreased insulin release
o Increased glucagon release
o Increased output of adrenal glucocorticoids and catecholamines

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23
Q

Elevated ALP, AST and bilirubins in acute pancreatitis indicates involvement of:

A

Gallbladder and pancreatic head

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24
Q

Initial diagnostic imaging modality in acute pancreatitis

A

Abdominal ultrasound

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25
Q

Criteria that categorized morphologic features of acute pancreatitis via CT scan:

A

Revised atlanta criteria

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26
Q

3 criteria for acute pancreatitis diagnosis (2 out 3)

A

o Typical abdominal pain in the epigastrium that may radiate to the back
o 3-fold or greater elevation in serum lipase and/or amylase
o Confirmatory findings of acute pancreatitis on cross-sectional abdominal imaging

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27
Q

4 markers of severity of acute pancreatitis

A

o Hemoconcentration (Hct > 44%)
o Admission azotemia (BUN > 22 mg/dL)
o SIRS
o Signs of organ failure

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28
Q

2 Differences between the biliary colic and acute pancreatitis abdominal pain

A

o Pain of biliary tract origin is more-right sided or epigastric than umbilical or left upper quadrant
o Ileus is usually absent

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29
Q

Criteria that defines phases of acute pancreatitis, outlines severity of acute pancreatitis, and clarifies imaging definition

A

Revised Atlanta criteria

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30
Q

2 phases of acute pancreatitis

A

o Early < 2 weeks

o Late > 2 weeks

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31
Q

Phase of acute pancreatitis where Severity is defined by clinical parameters rather than morphologic findings

A

Early phase

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32
Q

Most important clinical finding in regard to severity of the acute pancreatitis episode

A

Persistent organ failure – > 48 h

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33
Q

You must do CT imaging in the 1st 48 h of admission of acute pancreatitis: true or false

A

False

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34
Q

Radiographic feature of greatest importance to recognize in the late phase of acute pancreatitis

A

Necrotizing pancreatitis of CT

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35
Q

Difference between moderately severe and severe acute pancreatitis

A

o Moderately severe – transient organ failure (<48h)

o Severe – persistent organ failure (>48h)

36
Q

Diffuse pancreatic enlargement and homogenous contrast enhancement on CT scan

A

Interstitial pancreatitis

37
Q

Lack of pancreatic parenchymal enhancement by IV contrast on CT scan

A

Necrotizing pancreatitis

38
Q

Most important treatment intervention for acute pancreatitis

A

Safe, aggressive IV fluid resuscitation

39
Q

Better crystalloid for hydration in acute pancreatitis

A

Lactated Ringer’s

40
Q

What is safe, aggressive IV fluid resuscitation in acute pancreatitis

A

15-20 ml/kg (1050-1400) mL as initial bolus followed by 2-3 ml/kg/hr (200-250 mL/h) to maintain UO > 0.5 ml/kg/hr

41
Q

Why is Lactated Ringer’s solution a better crystalloid than NSS?

A

Decrease systemic inflammation

42
Q

Strategy wherein there is measurement of hematocrit and BUN every 8-12 hrs to ensure adequacy of fluid resuscitation

A

Targeted resuscitation strategy

43
Q

5 clinical and laboratory parameters in BISAP

A 
o	BUN > 25 mg/dL
o	Impaired mental status (GCS < 15)
o	SIRS
o	Age > 60 years
o	Pleural effusion
44
Q

BISAP score that indicates increased risk for in-hospital mortality

45
Q

Diet for mild acute pancreatitis (once abdominal pain resolved)

A

Low-fat solid diet

46
Q

Preferred nutrition for more severe cases after 2-3 days of admission

A

Enteral nutrition (preferred than TPN)

47
Q

Prophylactic antibiotics is recommended for necrotizing pancreatitis: True or false

A

False; broad spectrum antibiotic may be given if patient appears septic, then discontinued once with negative cultures

48
Q

Definitive management of infected pancreatic necrosis

A

Pancreatic debridement (necrosectomy)

49
Q

Persistent pancreatic fluid collections after 6 weeks

A

Pseudocyst

50
Q

Diagnosis of pancreatic duct disruption is confirmed by what diagnostic?

A

MRCP or ERCP

51
Q

> 90% effective at resolving the leak in pancreatic duct disruption

A

Bridging pancreatic stent (nonbridging are less effective)

52
Q

3 perivascular complications of acute pancreatitis:

A

o Splenic vein thrombosis
o Gastric varices
o Pseudoaneurysm

53
Q

Incidence of recurrent pancreatitis

A

25% of patients

54
Q

2 most common etiologic factors of recurrent pancreatitis

A

o Alcohol

o Cholelithiasis

55
Q

4 Cardinal manifestations of chronic pancreatitis

A

o Abdominal pain
o Steatorrhea
o Weight loss
o Diabetes mellitus

56
Q

Primary cause of chronic pancreatitis

57
Q

Independent, dose-dependent risk factor for chronic pancreatitis and recurrent acute pancreatitis

58
Q

Most frequent cause of chronic pancreatitis in children

A

Cystic fibrosis

59
Q

Pancreatitis that has the following histopathologic findings: Lymphoplasmacytic infiltrate, storiform fibrosis, abundant IgG4 cells

A

Autoimmune pancreatitis

60
Q

Marker for autoimmune pancreatitis

A

IgG4 – elevated in 2/3 of patients

61
Q

Criteria used in diagnosing autoimmune pancreatitis

A

Mayo Clinic HISORt criteria

62
Q

Parameters in Mayo Clinic HISORt criteria for AIP

A 
o	At least 1 or more of the following:
	Histology
	Imaging
	Serology
	Other organ involvement
	Response to glucocorticoid therapy
63
Q

Treatment of AIP that as dramatic response within 2- to 4-week course

A

Glucocorticoids

64
Q

Dose of prednisone in AIP

A

o Initial dose: 40 mg/day for 4 weeks

o Tapered by 5 mg/week

65
Q

Very effective at inducing and maintaining remission in AIP

66
Q

In chronic pancreatitis, patients seek medical attention predominantly because of 2 symptoms. What are these?

A

o Abdominal pain or maldigestion

o Weight loss

67
Q

2 tests used in evaluation of suspected pancreatic steatorrhea

A

o Fecal-elastase-1 – abnormal (low)

o Small bowel biopsy – normal

68
Q

Initial modality of choice in chronic pancreatitis

A

Abdominal CT imaging

69
Q

Test that has best sensitivity and specificity in chronic pancreatitis

A

Hormone stimulation test using secretin

70
Q

Radiographic findings that is pathognomonic for chronic pancreatitis

A

Diffuse calcifications on plain films

71
Q

Arterial bleeding into the pancreatic duct

A

Hemosuccus pancreaticus

72
Q

The cumulative risk of pancreatic carcinoma in chronic pancretitis

A

4% after 20 years

73
Q

Cornerstone of therapy in pancreatic steatorrhea

A

Pancreatic enzyme replacement

74
Q

Pancreatic enzyme replacement formulation must deliver sufficient amount of what substance into the duodenum to correct maldigestion and decrease steatorrhea?

75
Q

Hereditary pancreatitis is mutation on gene on what chromosome? What codons?

A

Chromosome 7, codons 29 and 122

76
Q

Incidence of pancreatic carcinoma in hereditary pancreatitis at age 70

77
Q

Ventral pancreatic anlage fails to migrate correctly to make contact with the dorsal anlage

A

Annular pancreas

78
Q

Ring of pancreatic tissue encircling the duodenum

A

Annular pancreas

79
Q

Surgical procedure of choice for annular pancreas

A

Retrocolic duodenojejunostomy

80
Q

Most common congenital anatomic variant of human pancreas

A

Pancreas divisum

81
Q

Pancreas divisum does not predispose patients to pancreatitis: True or false

82
Q

Appear as a small-caliber ventral duct with an arborizing pattern on ERCP/MRCP

A

Pancreas divisum

83
Q

Treatment of pancreatitis with pancreas divisum

A

o Conservative

o Endoscopic or surgical intervention only if with recurrence

84
Q

Diagnostic test for macroamylasemia

A

Serum chromatography

85
Q

Amylase circulate in the blood in a polymer form too large to be easily excreted by the kidney

A

Macroamylasemia

GASTROENTEROLOGY (2 decks)

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