Pancreatitis Flashcards
What cranial nerve plays a role in the physiology of the pancreas?
- Vagus nerve
What is required to stabilize trypsin in the acinar cells to prevent early activation?
- steady Ca+ levels
* low intracellular Ca+ causes spontaneous trypsin activation
What is the most common GI cause for admission?
- pancreatitis
Early activation of what enzyme is the most common cause of autodigestion of the pancreas?
Trypsin
What are the 2 most common causes of pancreatitis?
- Gallstones
- ETOH
What are the 2 less common causes of pancreatitis that was highlighted in red?
- hypertriglyceridemia
- trauma
What is the mnemonic used to remember causes of pancreatitis?
- I GET SMASHED
Gallstone pancreatitis usually occurs in the setting of ____________.
choledocholithiasis
What is the pathophysiology of ETOH pancreatitis?
- Nonoxidative ETOH metabolism in pancreases leads to fatty acid ethanol esters (FAEEs)
- accumulation of FAEE causes activation of trypsin
Hypertriglyceridemia is characterized as TGs greater than _______.
1000 mg/dL
What is the treatment for hypertriglyceridemia?
- High dose insulin infusion
How do you treat hypoglycemia d/t treatment with high dose insulin infusion for hypertriglyceridemia?
- high dextrose infusion
* titrate dextrose NOT insulin
Which of the following pancreatic types results in the blood supply being compromised?
a. interstitial
b. necrotizing
b. necrotizing
* more severe process, longer duration, 5-10% of cases
What is the major identifying symptom of pancreatitis?
a. pain
b. nausea, vomiting
c. weakness
d. diaphoresis
a. pain
What is the difference between the following 2 unusual findings seen with pancreatitis?
cellulens and grey turners
- cellulens = periumbilical ecchymosis
- grey turners = flank ecchymosis
*usually related to hemorrhagic pancreatitis
What is the diagnostic criteria for pancreatitis?
Must have 2/3
- abdominal pain
- lipase >3x normal
- imaging consistent with pancreatitis
What are the 2 reasons lipase is the preferred for diagnosing pancreatitis?
- stays elevated with ongoing damage
- amylase elevations can be seen in other processes
What LFT finding is 95% predictive for gallstone as the cause of pancreatitis?
- ALT > 3x normal
What is the most common radiologic finding of chronic pancreatitis?
- calcification within the pancreas
What criteria is used as a bedside index of severity in acute pancreatitis?
- Ranson’s criteria
What severity of pancreatitis is this?
Local complications without organ failure that is not likely to require ICU or hospitalization
a. mild
b. moderate
c. severe
a. mild
What severity of pancreatitis is this?
Transient organ failure or systemic complications. May or may not have necrosis.
a. mild
b. moderate
c. severe
b. moderate
What severity of pancreatitis is this?
Persistent single or multiple organ failure. High incidence of necrosis, sterile or infected.
a. mild
b. moderate
c. severe
c. severe
What are the goals (3) with fluid resuscitation in acute pancreatitis?
- urine output > 0.5 cc/kg/hr
- decreasing BUN
- stable H/H
