Pancreatitis - Adams

Question 1

What are the causes of epigastric pain?

Answer 1

• MI
• Aneurysm
  
  • AAA
• Gallbladder pathology
• Gastritis
• Esophageal varices
• Foreign body
• Crohn’s
• IBS
• Bowel obstruction
• Many many other causes . . .

Question 2

What is important in taking the history in evaluation of epigastric pain?

Answer 2

• Alcohol use
• Emesis/hematemesis
  
  • tolerate liquids/solids
• Onset of pain
• Radiation of pain
• Cardiac history
• Medications
• Allergies

Question 3

What is the typical clinical presentation of acute pancereatitis?

Answer 3

• Epigastric pain
  
  • may radiate to side/back
  • SEVERE, writhing
  • moderately fast onset (~30 min)
  • can’t get comfortable
• Shock (SIRS)
  
  • Low O₂ sats => Hypoxia
• N/V

Question 4

What laboratory findings are abnormal in acute pancreatitis?

Answer 4

• WBC increased
• Glucose increased
• Dehydration
• CRP elevated
• Pancreatic enzymes
  
  • Amylase
  • Lipase
    
    • more sensitive than amylase
    • might be normal in chronic pancreatitis
• Elevated triglycerides >1,000mg/dL
  
  • treat this before anything else!
• LDH & AST elevated
• Calcium low
• Albumin low

Question 5

What is the management for acute pancreatitis?

Answer 5

• IV hydration
• NPO
• Pain medication/control
• Antibiotics only in severe cases
• Typically improves in 3-7 days

Question 6

What is the best diagnostic imaging test for pancreatitis?

Answer 6

CT => see inflammation of pancrease

(80-95% accuracy for detection of necrosis)

Question 7

70% of pancreatitis is due to what etiology?

Answer 7

Alcohol

Question 8

What is the pathophysiology behind pancreatitis?

Answer 8

• Autodigestion
  
  • pancreatic enzymes digest tissues
  • becomes liquified
• Acute Edematous Pancreatitis occurs 1st
  
  • parenchymal edema + peripancreatic fat necrosis
• Hemorrhagic or Necrotizing Pancreatitis
  
  • when necrosis involves the parenchyma
  • with hemorrhage
  • gland dysfunction

Question 9

What is the reason behind calculating a patient’s Value of Ranson’s Criteria?

Answer 9

predict mortality after 48 hours

(likelihood of dying)

Question 10

What is the treatment for chronic pancreatitis?

Answer 10

• Enzyme therapy for malabsorption
• Reducing fat intake
• Medium chain triglycerides

Question 11

What are the complications of pancreatitis?

Answer 11

• Ascities
• Diabetes
• Malabsorption
• Vitamin deficiency
• Pancreatic pseudocyst