Pancreatitis - McGowan Flashcards
What calcium finding in acute pancreatitis?
Triglycerides?
Hct?
Coagulation?
Hypocalcemia
HyperTGs
Elevated (> 44%)
abnormal
Ransom criteria at admission?
GA-LAW Glucose > 200 Age > 55 LDH > 350 AST > 250 WBC > 16,000
What GI tumors does a MEN1 mutation cause?
Inheritance?
Insulinoma
Gastronoma (ZE)
AD
What pancreatic function tests are low in chronic pancreatitis?
Trypsinogen
Fecal elastase
How to treat infected pancreatic necrosis w/secondary gas formation?
Surgical debridement and Abs (imepenem/meropenem)
What ATLANTA criteria is transient organ failure < 48 hours w/local complications?
Moderate
What does imaging (xray) show in acute pancreatitis?
Sentinel loop
Colon cutoff sign
Calcified gallstones maybe
MEN2A can cause what tumors? With what elevations?
Medullary thyroid cancer (inc. calcitonin)
Pheochromocytoma (catecholamines)
Parathyroid (hypercalcemia)
Ransom criteria 48H after admission?
C and HOBBS Calcium < 8 Hct drop > 10% PaO2 < 60 Base deficit > 4 BUN increases > 5 Sequestration of fluid > 6L
RF for acute pancreatitis?
Smoking
High glycemic load
Fat belly
Old age and obesity
What genetic defects are associated with chronic pancreatitis?
CFTR
PSTI
SPINK1
PRSS1
Give the symptomatic severity index scores w/%’s for CT grades
1 - 0%
4 - < 3 %
7 - 6%
10 - > 17%
What is accompanied by marfanoid body habits?
Neuromas of lips and tongue
Autoimmune pancreatitis has what association?
Hypergammaglobuminemia (IgG4)
Elevated ANA
What does the endocrine pancreas make?
Exocrine?
SIG: somatostatin, insulin, glucagon
PAL: protease, amylase, lipase
What is the main cause of death in chronic pancreatitis?
Pancreatic cancer
Tumefactive chronic pancreatitis is a concern for what?
Pancreatic cancer
The hypothesis of pathogenesis of chronic pancreatitis?
SAPE
Initiating event
How do you treat hypocalcemia with tetany?
Calcium gluconate IV
How is Pancreatic insufficiency detected?
Malabsorption of what?
80% of ppl develop what after 25 years of chronic pancreatitis?
Decreased fecal chymotrypsin
B12
DM
When should rapid-bolus IV contrast-enhanced CT be avoided?
Serum Cr > 1.5 mg/dL
Autoimmune pancreatitis has antibody to what?
Lactoferrin
CAII
What gene mutation does Hirschsprung disease develop in 2-5%?
MEN2A
What APACE score correlates with higher mortality?
> 8
How do you drain a pseudocyst?
Endoscopic US
3 bigges complications of severe acute pancreatitis (SAP)?
3rd spacing, pre-renal azotemia
Pseudocyst
ARDS
How to diagnose acute pancreatitis?
2 of 3:
Epigastric pain
Lipase and amylase 3x ULN
CT changes consistent w/pancreatitis
What do you start w/in 48 hours of admission in SAP?
Enteral feedings w/NG or NJ tube
