Pancreatitis Adams

Question 1

Relationship between pancreatitis and low O2 sats?

Answer 1

Lungs respond to the leak from the pancreas (similar to shock mechanism) —Phospholipase A from pancreas affects pulmonary system causing ARDS

Question 2

What imaging do you want to do for the pancreas?

Answer 2

CT

Graded…higher grade is a worse problem

*ultrasound doesn’t show you much

Question 3

2 types of pancreatitis

Answer 3

acute and chronic

Question 4

Common cause of pancreas (70 %) ?

Answer 4

Alcohol!

Question 5

Cholelithiasis

Answer 5

Stones can lodge in pancreatic duct or ampulla of Vater and cause an obstruction and subsequent extravasation of enzymes into parenchyma

Question 6

Other than alcohol, what is a common cause of pancreatitis?

Answer 6

ELEVATED TRIGLYCERIDES!
>1000 mg/dL

*Tx this!! Above 500 you start worrying about it

Question 7

Why can the pancreas become liquified?

Answer 7

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

Question 8

What is “acute edematous pancreatitis”?

Answer 8

Parenchymal edema and peripancreatic fat necrosis that occurs first in pancreatitis

Question 9

After acute edematous pancreatitis, necrosis involves the parenchyma along with hemorrhage and gland dysfunction….what is this called?

Answer 9

Hemorrhagic or necrotizing pancreatitis

Question 10

Symptoms of pancreatitis

Answer 10

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%)

Question 11

Pancreatitis exam findings

Answer 11

Appear ill
Holding abdomen and likely moving around bc can’t get comfortable

Tender epigastrium

Question 12

What 2 signs are UNCOMMON but classically described with severe hemorrhagic pancreatitis caused by leaking retroperitoneal blood?

Answer 12

Cullen’s sign (periumbilical ecchymosis)

Gray turner sign (flank ecchymosis)

Question 13

Lab test for pancreatitis?

Answer 13

Lipase!!

More sensitive and specific than amylase (which is also increased)

30 % of the time it can be normal

Question 14

What can you see in the WBC in pancreatitis?

Answer 14

Increased WBC and left shift

Question 15

Value of Ranson’s Criteria?

Answer 15

Predict mortality after 48 hours of acquired information

**not used to predict mortality at admission

Question 16

What are you looking for in acute pancreatitis on CT?

Answer 16

swelling and inflammation around pancreas

Question 17

What is a Sentinel loop?

Answer 17

Dilated loop of small bowel filled with air near the pancreas

Question 18

Tx for pancreatitis?

Answer 18

IV hydration
NPO (nothing oral)
Pain control–any narcotic

Question 19

Treatable causes of pancreatitis?

Answer 19

Stop potentially causative meds

Pull stone out if cholelithiasis

Tx elevated calcium

Question 20

Course of pancreatitis?

Answer 20

lasts 3-7 days

Question 21

Chronic pancreatitis CT findings?

Answer 21

Protein plugs & calcifications –atrophy and fibrosis

Question 22

Tx for chronic pancreatitis?

Answer 22

Enzyme therapy for malabsorption

Pain control

Reduction in fat intake

Question 23

Complications of chronic pancreatitis?

Answer 23

Ascites
Diabetes
Etc.

Question 24

What do BP, HR, and RR look like in pancreatitis?

Answer 24

BP low

HR and RR increased

Question 25

What happens to serum Ca++ in pancreatitis?

Answer 25

Low

Question 26

What happens to serum albumin in pancreatitis?

Answer 26

Low

Question 27

What does Ranson’s criteria predict?

Answer 27

Mortality after 48 hours