Pancreatitis

Question 1

Causes of pancreatitis

Answer 1

Gallstones (acute and ususally in women)

Alcohol abuse for at least 5 years (chronic and usually in men)

Question 2

Symptoms of pancreatitis

Answer 2

N/V Severe pain - pt is reluctant to take a deep breath Pain is worse supine LUQ/epigastric pain that radiates to the back They will appear sick.

Question 3

Labs for pancreatitis

Answer 3

Acute: amylase and lipase are elevated 6-12 hours after onset of sx.

Chronic: blood glucose and fecal fat. - looking for steatorrhea

Question 4

Revised Atlanta Classification Criteria

Answer 4

Must meet 2 of the 3 criteria 1. Abdominal pain consistent with pancreatitis 2. Serum amylase or lipase 3x upper limit of normal 3. Radiographic findings consistent w/ pancreatitis

Question 5

Name 3 primary differentials for pancreatitis

Answer 5

MI Bowel obstruction Acute cholecystitis

Question 6

Goals of therapy for pancreatitis

Answer 6

Rehydration Correct predisposing factors (removal of gallstones)

Question 7

What are symtoms of pancreatitis in children?

Answer 7

Nonspecific symptoms

nausea and vomiting

Question 8

Pancreatitis management

Answer 8

Hospitalization

IV fluids

Pain meds

Patients will f/u in primary care to check symptoms and recheck labs.

Question 9

Complications of pancreatitis

Answer 9

Multisystem organ failure

Question 10

Which is the most common cause of pancreatitis in the United States?

1. Ethyl alcohol
2. Gallstones
3. Hyperlipidemia
4. Trauma

Question 11

A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The examiner notes both direct and rebound tenderness with palpation of the abdomen. What is the significance of this finding?

1. Compression of the common bile duct
2. Presence of a pancreatic pseudocyst
3. Retroperitoneal hemorrhage
4. Severe acute pancreatitis with peritonitis

Answer 11

ANS: D

Direct and rebound tenderness is an ominous sign suggesting severe peritonitis. Jaundice is present with compression of the common bile duct. Palpation of a mass suggests the presence of a pancreatic pseudocyst. Bruising of the periumbilicus or flank suggests retroperitoneal hemorrhage

Question 12

The provider suspects that a patient has chronic pancreatitis. Which diagnostic tests will be most helpful to confirm this diagnosis?

1. Blood glucose and fecal fat
2. Complete blood count
3. Liver function tests
4. Serum amylase and lipase levels

Answer 12

ANS: A

Patients with pancreatic insufficiency will have elevated blood glucose levels and steatorrhea. The CBC, LFTs, and serum amylase and lipase are typically normal with chronic pancreatitis.

Question 13

When do you do a CT for pancreatitis?

Answer 13

If symptoms do not improve in 48 hours get CT w/ contrast