Pancreatitis Adams Flashcards
Relationship between pancreatitis and low O2 sats?
Lungs respond to the leak from the pancreas (similar to shock mechanism) —Phospholipase A from pancreas affects pulmonary system causing ARDS
What imaging do you want to do for the pancreas?
CT
Graded…higher grade is a worse problem
*ultrasound doesn’t show you much
2 types of pancreatitis
acute and chronic
Common cause of pancreas (70 %) ?
Alcohol!
Cholelithiasis
Stones can lodge in pancreatic duct or ampulla of Vater and cause an obstruction and subsequent extravasation of enzymes into parenchyma
Other than alcohol, what is a common cause of pancreatitis?
ELEVATED TRIGLYCERIDES!
>1000 mg/dL
*Tx this!! Above 500 you start worrying about it
Why can the pancreas become liquified?
It can autodigest itself! The enzymes of the pancreas are secreted as proenzymes but they become active in the pancreas and can cause its own destruction
What is “acute edematous pancreatitis”?
Parenchymal edema and peripancreatic fat necrosis that occurs first in pancreatitis
After acute edematous pancreatitis, necrosis involves the parenchyma along with hemorrhage and gland dysfunction….what is this called?
Hemorrhagic or necrotizing pancreatitis
Symptoms of pancreatitis
Mid-epigastric pain (95%)
Severe
Moderately rapid onset (about 30 minutes)
Progressive and constant (does NOT come and go)
Can radiate to the back (50%)
Nausea/vomiting (60-80%)
Pancreatitis exam findings
Appear ill
Holding abdomen and likely moving around bc can’t get comfortable
Tender epigastrium
What 2 signs are UNCOMMON but classically described with severe hemorrhagic pancreatitis caused by leaking retroperitoneal blood?
Cullen’s sign (periumbilical ecchymosis)
Gray turner sign (flank ecchymosis)
Lab test for pancreatitis?
Lipase!!
More sensitive and specific than amylase (which is also increased)
30 % of the time it can be normal
What can you see in the WBC in pancreatitis?
Increased WBC and left shift
Value of Ranson’s Criteria?
Predict mortality after 48 hours of acquired information
**not used to predict mortality at admission
What are you looking for in acute pancreatitis on CT?
swelling and inflammation around pancreas
What is a Sentinel loop?
Dilated loop of small bowel filled with air near the pancreas
Tx for pancreatitis?
IV hydration
NPO (nothing oral)
Pain control–any narcotic
Treatable causes of pancreatitis?
Stop potentially causative meds
Pull stone out if cholelithiasis
Tx elevated calcium
Course of pancreatitis?
lasts 3-7 days
Chronic pancreatitis CT findings?
Protein plugs & calcifications –atrophy and fibrosis
Tx for chronic pancreatitis?
Enzyme therapy for malabsorption
Pain control
Reduction in fat intake
Complications of chronic pancreatitis?
Ascites
Diabetes
Etc.
What do BP, HR, and RR look like in pancreatitis?
BP low
HR and RR increased
What happens to serum Ca++ in pancreatitis?
Low
What happens to serum albumin in pancreatitis?
Low
What does Ranson’s criteria predict?
Mortality after 48 hours
