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Clinical Decision Making Exam 1 > Pancreatitis Case > Flashcards

Pancreatitis Case Flashcards

1
Q

location of pancreatitis pain:

might radiate to:

A

epigastric/RUQ

back

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2
Q

pancreatitis pain may feel better with:

and worse with:

A

witting up

laying down

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3
Q

what is this showing

A

cullen sign

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4
Q

what is this showing

A

grey-turner sign

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5
Q

cullen sign is bruising in the __ area

A

umbilical

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6
Q

grey-turner sign is bruising around the __

A

flanks

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7
Q

lipase rises w.in __ hours of pancreatitis sx,

peaks at __ hours,

and normalizes w.in __ days

A

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

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8
Q

is amylase or lipase more specific for acute pancreatitis

A

lipase

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9
Q

does amylase or lipase remain elevated longer in pancreatitis

A

lipase

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10
Q

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

A

alcoholic

hypertriglyceridemia

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11
Q

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

A

3x

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12
Q

2 imaging choices for pancreatitis

A

CT with contrast

US

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13
Q

CT w. contrast findings in pancreatitis (2)

A

diffuse pancreatic enlargement w. edema

peripancreatic fat stranding

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14
Q

2 US findings in pancreatitis

A

diffuse enlarged pancreas

gallstones in gallbladder/bile duct

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15
Q

ddx for pancreatitis

A

choledocholithiasis

gastritis

cholangitis

cholecystitis

perforated viscous

SBO

mesenteric ischemia

hepatitis

scorpion sting

MI

PE

COVID

food poisoning

IBD

IBS

pericarditis

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16
Q

dx for pancreatitis requires presence of __

of what symptoms

A

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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17
Q

4 etiologies for pancreatitis

A

gallstones

etoh

hyperlipidemia

post-ERCP

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18
Q

mc cause of pancreatitis

A

gallstones

19
Q

2 possible causes of gallstone related pancreatitis

A

ampulla obstruction 2/2 to stones or edema

reflux of bile into pancreatic duct during stone passing

20
Q

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

A

5 years

21
Q

parameters for heavy drinking

men:

women:

A

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

22
Q

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

A

1000

23
Q

4 toxic causes of pancreatitis

A

ethanol

methanol

scorpion venom

organophosphate poisoning

24
Q

indications for mild pancreatitis (2)

A

no organ failure

no local or systemic complications

25
Q

indications for moderate pancreatitis (2)

A

no organ failure or transient organ failure < 48 hr

local complications

26
Q

indications for severe pancreatitis (2)

A

persistent organ failure > 48 hr involving 1 or more organs

27
Q

which has a worse outcome: edematous pancreatitis or necrotizing pancreatitis

A

necrotizing

28
Q

scoring systems for severity of pancreatitis

A

ranson’s

APACHE II

SIRS

BISAP

harmless acute score

CT severity index

29
Q

problem w. severity scoring systems for pancreatitis

A

poor accuracy

30
Q

initial management pancreatitis (3)

A

aggressive fluids

pain control

NPO

31
Q

preferred type of fluids for pancreatitis management (2)

A

LR

isotonic crystalloid

32
Q

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

A

hypotn

ATN

decreased organ perfusion

necrosis

33
Q

benefits of fluid replacement in pancreatitis pt

A

reduced m&m

pain control

34
Q

how does inadequate fluid resuscitation lead to increased pain in pancreatitis

A

hypovolemia → ischemia → pain

35
Q

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

A

normalization of HR and BP

urine output

reduction in H&H

reduction in BUN

36
Q

choice of pain med for acute pancreatitis

A

opioids

37
Q

2 commonly used opioids for acute pancreatitis

A

hydromorphone

fentanyl

38
Q

indications for pancreatitis pt to resume PO

A

no ileus

no n/v

PO tolerated

39
Q

initial PO diets for pancreatitis pt

A

low residue

low fat

soft

40
Q

indication for nutrition support

A

NPO x 5 days

41
Q

management for pancreatitis w. gallstones

A

ERCP w.in < 24 hr

cholecystectomy after recovery for all

42
Q

management of hypertriglyceridemia-induced pancreatitis (4)

A

severe restriction of dietary fat

+/- plasmapheresis or IV insulin

pharm management of lipids

weight loss

43
Q

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

A

prediabetes/diabetes

Clinical Decision Making Exam 1 (22 decks)

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