Pancreatitis Flashcards
There's a lot in here. Focusing on the take-home points at the end of the lecture.
What are the Atlanta Symposium (1992) criteria for acute pancreatitis?
At least 2 of the following: - Typical pancreatic type pain. - Radiographic findings of pancreatitis - Elevated blood chemistries (amylase and/or lipase) (Pain, radiographic, chemistries)
What is pain from pancreatitis like?
Severe, steady pain in bandlike pattern - often radiating to the back.
(hurts a lot, pain lasts for days)
- note that 5-10% of acute pancreatitis is painless.
Is vomiting a common presenting sign in pancreatitis?
Yes. 90% vomit.
What are the 2 main etiologies of acute pancreatitis?
Alcohol
Biliary
Where must a stone be to cause pancreatitis?
In the duodenal papilla.
a stone in the common bile duct will just cause cholangitis
What test is pretty good at telling you if pancreatitis is from a biliary cause?
Elevated ALT (>150)
What are a few mechanisms that may contribute to acute alcoholic pancreatitis?
Abnormal blood flow / secretion.
Toxic metabolites, mitochondrial damage, lysosome instability (ROS, etc.).
Sensitization to CCK (Zymogens and cytokines).
Sphincter of Oddi spasms.
(and increased triglycerides?)
What mainly catalyzes the damage in acute pancreatitis?
Premature / intracellular activation of trypsin.
It activates other enzymes -> autodigestion.
How does high Ca++ predispose to acute pancreatitis?
High Ca++ leads to trypsin activation (maybe)
What are the 3 mainstays of acute pancreatitis treatment?
Bowel rest, IV fluids, and pain control.
How can enteral feeding be done in severe acute pancreatitis?
Feeding beyond the ligament of Treitz.
What are 2 types of acute pancreatitis with different severity levels? How can these be distinguished with imaging?
Interstitial - look “patchy” on CT
Necrotizing - worse - big dark areas of pancreas on CT.
What is Cullen’s sign?
Blood near umbilicus
What is Grey Turner’s sign?
Retroperitoneal blood.
What should you rule out if you see acute pancreatitis in someone over 50?
Pancreatic cancer.
What are the 2 “mortality peaks” from acute pancreatitis?
Necrotizing/severe pancreatitis causes mortality earlier.
Infection of necrotizing pancreatitis can cause mortality later on.
What are 5 diagnostic signs of chronic pancreatitis?
Calcifications Pancreatic duct stones Dilate irregular pancreatic duct without mass. Dilate side branches. Atrophy without a mass.
What’s one of the earliest ways to detect chronic pancreatitis? (before structural damage)
Secretin stimulation test - test duodenal bicarb levels after secretin stimulation.
What can biopsy and endoscopic ultrasound show you when there’s chronic pancreatitis?
Fibrosis (maybe other things as well…)
3 possible etiologies of chronic pancreatitis?
Ductal obstruction -> trypsin activation in ducts. Toxic / metabolic (EtOH, smoking, etc.) -> oxidative stress... fibrosis. Necrosis fibrosis (after acute inflammatory attacks) - a messed up healing process, "like a keloid scar"
What are two modalities for seeing duct abnormalities?
MRCP (MRI) - can see earlier changes?
ERCP
3 main consequences of chronic pancreatitis?
3 other consequences?
Pain
Steatorrhea
Diabetes
(billiary obstruction, B12 def, cancer)
Is CP pain serious stuff?
Yeah.
Review: How much pancreas function do you have to lose to get steatorrhea?
about 90% - it’s a late sign.
How does diabetes of chronic pancreatitis (“Type 3 diabetes”?) differ from T2D?
It’s very sensitive to insulin - it’s caused by a lack of insulin production, not insulin resistance.
(but you can still use metformin..)
3 treatments for chronic pancreatitis?
Enzymes (replace what’s not being made).
Duct decompression by surgery.
ERCP (endoscopy… to remove blockages?).
