Pancreatitis - McGowan

Question 1

What calcium finding in acute pancreatitis?

Triglycerides?

Hct?

Coagulation?

Answer 1

Hypocalcemia

HyperTGs

Elevated (> 44%)

abnormal

Question 2

Ransom criteria at admission?

Answer 2

GA-LAW
Glucose > 200
Age > 55
LDH > 350
AST > 250
WBC > 16,000

Question 3

What GI tumors does a MEN1 mutation cause?

Inheritance?

Answer 3

Insulinoma
Gastronoma (ZE)

AD

Question 4

What pancreatic function tests are low in chronic pancreatitis?

Answer 4

Trypsinogen

Fecal elastase

Question 5

How to treat infected pancreatic necrosis w/secondary gas formation?

Answer 5

Surgical debridement and Abs (imepenem/meropenem)

Question 6

What ATLANTA criteria is transient organ failure < 48 hours w/local complications?

Answer 6

Moderate

Question 6

What does imaging (xray) show in acute pancreatitis?

Answer 6

Sentinel loop
Colon cutoff sign
Calcified gallstones maybe

Question 7

MEN2A can cause what tumors? With what elevations?

Answer 7

Medullary thyroid cancer (inc. calcitonin)

Pheochromocytoma (catecholamines)

Parathyroid (hypercalcemia)

Question 8

Ransom criteria 48H after admission?

Answer 8

C and HOBBS
Calcium < 8
Hct drop > 10%
PaO2 < 60
Base deficit > 4
BUN increases > 5
Sequestration of fluid > 6L

Question 10

RF for acute pancreatitis?

Answer 10

Smoking
High glycemic load
Fat belly
Old age and obesity

Question 12

What genetic defects are associated with chronic pancreatitis?

Answer 12

CFTR
PSTI
SPINK1
PRSS1

Question 13

Give the symptomatic severity index scores w/%’s for CT grades

Answer 13

1 - 0%
4 - < 3 %
7 - 6%
10 - > 17%

Question 14

What is accompanied by marfanoid body habits?

Answer 14

Neuromas of lips and tongue

Question 15

Autoimmune pancreatitis has what association?

Answer 15

Hypergammaglobuminemia (IgG4)

Elevated ANA

Question 16

What does the endocrine pancreas make?

Exocrine?

Answer 16

SIG: somatostatin, insulin, glucagon

PAL: protease, amylase, lipase

Question 17

What is the main cause of death in chronic pancreatitis?

Answer 17

Pancreatic cancer

Question 18

Tumefactive chronic pancreatitis is a concern for what?

Answer 18

Pancreatic cancer

Question 19

The hypothesis of pathogenesis of chronic pancreatitis?

Answer 19

SAPE

Initiating event

Question 21

How do you treat hypocalcemia with tetany?

Answer 21

Calcium gluconate IV

Question 22

How is Pancreatic insufficiency detected?

Malabsorption of what?

80% of ppl develop what after 25 years of chronic pancreatitis?

Answer 22

Decreased fecal chymotrypsin

B12

DM

Question 23

When should rapid-bolus IV contrast-enhanced CT be avoided?

Answer 23

Serum Cr > 1.5 mg/dL

Question 24

Autoimmune pancreatitis has antibody to what?

Answer 24

Lactoferrin

CAII

Question 25

What gene mutation does Hirschsprung disease develop in 2-5%?

Answer 25

MEN2A

Question 26

What APACE score correlates with higher mortality?

Answer 26

> 8

Question 27

How do you drain a pseudocyst?

Answer 27

Endoscopic US

Question 27

3 bigges complications of severe acute pancreatitis (SAP)?

Answer 27

3rd spacing, pre-renal azotemia
Pseudocyst
ARDS

Question 28

How to diagnose acute pancreatitis?

Answer 28

2 of 3:
Epigastric pain
Lipase and amylase 3x ULN
CT changes consistent w/pancreatitis

Question 28

What do you start w/in 48 hours of admission in SAP?

Answer 28

Enteral feedings w/NG or NJ tube