Pancreatitis Case Flashcards by Alice Richards

location of pancreatitis pain:

might radiate to:

epigastric/RUQ

back

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pancreatitis pain may feel better with:

and worse with:

witting up

laying down

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what is this showing

cullen sign

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what is this showing

grey-turner sign

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cullen sign is bruising in the __ area

umbilical

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grey-turner sign is bruising around the __

flanks

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lipase rises w.in __ hours of pancreatitis sx,

peaks at __ hours,

and normalizes w.in __ days

rises: 4-8 hr
peaks: 24 hr
normalizes: 8-14 days

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is amylase or lipase more specific for acute pancreatitis

lipase

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does amylase or lipase remain elevated longer in pancreatitis

lipase

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amylase is less sensitive than lipase for which two types of pancreatitis

alcoholic

hypertriglyceridemia

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in acute pancreatitis, lipase/amylase are usually elevated > __ the upper nl

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2 imaging choices for pancreatitis

CT with contrast

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CT w. contrast findings in pancreatitis (2)

diffuse pancreatic enlargement w. edema

peripancreatic fat stranding

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2 US findings in pancreatitis

diffuse enlarged pancreas

gallstones in gallbladder/bile duct

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ddx for pancreatitis

choledocholithiasis

gastritis

cholangitis

cholecystitis

perforated viscous

SBO

mesenteric ischemia

hepatitis

scorpion sting

COVID

food poisoning

IBD

IBS

pericarditis

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dx for pancreatitis requires presence of __

of what symptoms

2 out of 3:

acute onset of persistent, severe, epigastric pain

elevated lipase or amylase 3x greater than upper nl

characteristic findings of acute pancreatitis on imaging

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4 etiologies for pancreatitis

gallstones

etoh

hyperlipidemia

post-ERCP

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mc cause of pancreatitis

gallstones

2 possible causes of gallstone related pancreatitis

ampulla obstruction 2/2 to stones or edema

reflux of bile into pancreatic duct during stone passing

consider etoh pancreatitis if a pt has been a heavy drinker for at least

5 years

parameters for heavy drinking

men:

women:

men: 14 or more drinks/week
women: 7 or more drinks/week

for hyperlipidemia related pancreatitis, serum TG need to be > __

1000

4 toxic causes of pancreatitis

ethanol

methanol

scorpion venom

organophosphate poisoning

indications for mild pancreatitis (2)

no organ failure

no local or systemic complications

indications for moderate pancreatitis (2)

no organ failure or transient organ failure \< 48 hr local complications

indications for severe pancreatitis (2)

persistent organ failure \> 48 hr involving 1 or more organs

which has a worse outcome: edematous pancreatitis or necrotizing pancreatitis

necrotizing

scoring systems for severity of pancreatitis

ranson's APACHE II SIRS BISAP harmless acute score CT severity index

problem w. severity scoring systems for pancreatitis

poor accuracy

initial management pancreatitis (3)

aggressive fluids pain control NPO

preferred type of fluids for pancreatitis management (2)

LR isotonic crystalloid

inadequate hydration in a pancreatitis pt can lead to (4)

hypotn ATN decreased organ perfusion necrosis

benefits of fluid replacement in pancreatitis pt

reduced m&m pain control

how does inadequate fluid resuscitation lead to increased pain in pancreatitis

hypovolemia → ischemia → pain

clues to know you have adequately fluid resuscitated pt (4)

normalization of HR and BP urine output reduction in H&H reduction in BUN

choice of pain med for acute pancreatitis

opioids

2 commonly used opioids for acute pancreatitis

hydromorphone fentanyl

indications for pancreatitis pt to resume PO

no ileus no n/v PO tolerated

initial PO diets for pancreatitis pt

low residue low fat soft

indication for nutrition support

NPO x 5 days

management for pancreatitis w. gallstones

ERCP w.in \< 24 hr cholecystectomy after recovery for all

management of hypertriglyceridemia-induced pancreatitis (4)

severe restriction of dietary fat +/- plasmapheresis or IV insulin pharm management of lipids weight loss

pt's w. acute pancreatitis are at risk for developing ___ long term

prediabetes/diabetes