Pancreatitis Flashcards
What is necessary for severe acute pancreatitis?
Surrounding retroperitoneal fat.
What is the diagnostic criteria for acute pancreatitis?
Have 2 of the following:
(1) pancreatic-type pain
(2) radiographic findings
(3) elevated amylase, lipase, etc. in blood chemistries
What is the clinical presentation of acute pancreatitis?
(1) severe, steady, band-like pain in the upper abdomen that radiates to the back
(2) vomiting
(3) quick onset and lasts for days
What are common early complications of acute pancreatitis?
(1) SIRS
(2) hypotension
(3) ileus
(4) renal failure
(5) third spacing / ascites
(6) hypoxia
(7) acidosis
(8) cholangitis
(9) hypocalcemia
(10) multisystem organ failure
(11) intraabdominal hemorrhage
(12) death
What are common late complications of acute pancreatitis?
(1) gut failure / malnutrition
(2) hypoalbuminemia
(3) necrosis / abscess
(4) biliary obstruction
(5) hospital-acquired infections
(6) chronic ventilator dependence
(7) pseudocysts
(8) splenic vein thrombosis
(9) death
What is cholangitis?
An infection of the common biliary duct that presents with:
(1) fever
(2) right upper quadrant pain
(3) jaundice
What is the first event in acute pancreatitis?
Trypsin becomes activated in pancreatic acinar cells.
What are the 2 most common causes of acute pancreatitis?
(1) alcohol
(2) biliary stones
J: This medical procedure is a potential cause of acute pancreatitis.
What is endoscopic retrograde cholangiopancreatography (ERCP)?
What metabolic conditions are a potential causes of acute pancreatitis?
(1) hypertriglyceridemia
(2) hypercalcemia
What is the pathogenesis of biliary acute pancreatitis?
(1) The papilla of Vater is blocked by a gallstone
(2) Bile builds up and enters the pancreatic duct causing damage, inflammation, etc.
What histories are often seen in alcohol-induced acute pancreatitis?
(1) fairly high doses for at least a few years
(2) 24 hours post-binge
What are potential mechanisms for alcohol-induced acute pancreatitis?
(1) mitochondrial damage leading to lysosome instability and oxidative stress
(2) poor blood flow
(3) sensitization to CCK leading to zymogen activation and cytokine generation
Besides gallstones, what are some obstructive causes of acute pancreatitis?
(1) adenocarcinoma
(2) ampullary tumors
(3) pancreatic duct stricture
(4) annular pancreas
What drugs can cause acute pancreatitis?
(1) HIV drugs (didanosine, pentamidine)
(2) thiazides
(3) ACE inhibitors
(4) valproic acid
(5) estrogen
What are aggressive factors in the body that contribute to acute pancreatitis?
(1) bile
(2) low pH
(3) trypsin
(4) high calcium and triglycerides
(5) CCK
(6) vagal stimulation / gastric distention
What are protective factors in the body against acute pancreatitis?
(1) SPINK1
(2) somatostatin
Hw is acute pancreatitis treated?
(1) IV fluids and pain control
(2) close monitoring
(3) ultrasound of gallbladder
(4) GI consult for cholangitis, biliary obstruction
(5) surgery consult for gallstone, infected necrosis
(6) antibiotics for necrosis, cholangitis
J: This refers to peritoneal blood in the umbilicus, indicating acute pancreatitis.
What is Cullen’s sign?
J: This refers to hemorrhage in the retroperitoneum, indicating acute pancreatitis.
What is Grey-Turner’s sign?
What are some signs of chronic pancreatitis?
(1) pancreatic calcifications
(2) pancreatic duct stones
(3) dilated, irregular pancreatic duct without a mass
(4) atrophy without a mass
What are some false signs for chronic pancreatitis?
(1) chronic elevations in amylase and lipase
(2) relapsing acute pancreatitis
(3) post-surgical exocrine dysfunction
(4) isolated steatorrhea
(5) swelling of the pancreatic head
What’s the most common cause of chronic pancreatitis?
Alcohol & tobacco.
What are the 3 hypotheses as to the pathophysiology of chronic pancreatitis?
(1) ductal obstruction
(2) toxic / metabolic
(3) necrosis / fibrosis
Explain the ductal obstruction hypothesis for chronic pancreatitis.
(1) Protein precipitates and calcifies in ducts.
(2) Trypsin is activated.
(3) There is inflammation upstream, followed by apoptosis and fibrosis of upstream acini.
Explain the toxic / metabolic hypothesis for chronic pancreatitis.
Oxidative stress from alcohol, CCK stimulation, or smoking leads to stellate cell activation and fibrosis.
Explain the necrosis / fibrosis hypothesis for chronic pancreatitis.
(1) Acute inflammation leads to necrosis.
(2) Cytokines from macrophages lead to chronic damage and an anti-inflammatory fibrotic “healing” state.
(3) Fibrosis leads to local ischemia, causing more necrosis.
What are consequences of chronic pancreatitis?
(1) pain
(2) steatorrhea
(3) diabetes
(4) biliary obstruction
(5) B12 deficiency
(6) cancer
How is pain from chronic pancreatitis managed?
(1) high dose, non-enteric, coated pancreatic enzymes
(2) quit alcohol and tobacco
(3) neural modulators
(4) narcotics
(5) remove stones and dilate strictures
(6) surgery
How does diabetes due to chronic pancreatitis differ from typical diabetes?
(1) There is no glucagon or somatostatin, so hypoglycemia is more of an issue
(2) Usually no ketoacidosis
(3) Very insulin sensitive peripherally
What characterizes the early and late causes of mortality in acute pancreatitis?
Early: organ failure
Late: infection
What tests are used to diagnose chronic pancreatitis?
(1) X-ray
(2) MRI (MRCP)
(3) ultrasound
(4) endoscopic ultrasound
(5) ERCP
(6) stool studies
(7) function tests
