Pancreatitis Case Flashcards
location of pancreatitis pain:
might radiate to:
epigastric/RUQ
back
pancreatitis pain may feel better with:
and worse with:
witting up
laying down
what is this showing
cullen sign
what is this showing
grey-turner sign
cullen sign is bruising in the __ area
umbilical
grey-turner sign is bruising around the __
flanks
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
is amylase or lipase more specific for acute pancreatitis
lipase
does amylase or lipase remain elevated longer in pancreatitis
lipase
amylase is less sensitive than lipase for which two types of pancreatitis
alcoholic
hypertriglyceridemia
in acute pancreatitis, lipase/amylase are usually elevated > __ the upper nl
3x
2 imaging choices for pancreatitis
CT with contrast
US
CT w. contrast findings in pancreatitis (2)
diffuse pancreatic enlargement w. edema
peripancreatic fat stranding
2 US findings in pancreatitis
diffuse enlarged pancreas
gallstones in gallbladder/bile duct
ddx for pancreatitis
choledocholithiasis
gastritis
cholangitis
cholecystitis
perforated viscous
SBO
mesenteric ischemia
hepatitis
scorpion sting
MI
PE
COVID
food poisoning
IBD
IBS
pericarditis
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
4 etiologies for pancreatitis
gallstones
etoh
hyperlipidemia
post-ERCP
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
