S09C82 - Pacreatitis and Cholecystitis Flashcards
1
Q
Pancreatitis: causes
A
- gallstones 35-40%
- alcohol is second most common cause
- 5% of pts get pancr. after ERCP
- hypertriglyceridemia occurs in 1-4% of cases, assoc with levels >11mmol/L
- post-op complication
- infxn (legionella, leptospira, mycoplasma, salmonella) (mumps, coxsackie, CMV, echovirus, HBV) (ascaris, cryptosporidium, toxoplasma)
- hypercalcemia
- hyperparathyroidism
- ischemia
- posterior penetrating ulcer
- scorpion venom
- organophosphates
- tumor
- oddie sphincter dysfunction
- pancreas divisum
2
Q
Pacreatitis: pathophys
A
- unregulated activation and lack of elimination of trypsin
- trypsin activates digestive enzymes and autodigestion occurs, inflm, injury, acinar cell necrosis, pseudocyst formation, abscess
3
Q
Pancreatitis: Rx causes
A
- azathioprine
- valproic
- mesalamine
- estrogens
- opiates
- tetracycline
- steroids
- septra
- lasix
- rifampicin
- lamivudine
- octreotide
- carbamazepine
- acetaminophen
- enalapril
- HCTZ
- cisplatin
- erythromycin
- cyclopenthiazide
4
Q
Pancreatitis: Dx
A
2 of the following:
- characteristic abdo pain
- serum lipase 3x normal
- findings on us or CT
5
Q
Pancreatitis: investigations
A
- CBC, metabolic panel (BUN, Cr, gluc, lytes)
- calcium level
- liver studies
- LDH
- albumin
- triglycerides
- u/a
- ABG
6
Q
Lipase
A
- -lipase >600IU/L has a specificity of 95% (80%Sn), remains high for 8-14d
- may be raised in other pathologies or renal insufficiency
7
Q
Pancreatitis: imaging
A
- AXR: localized ileus (Sentinel loop), generalized ileus with a-f levels, colon cut-off sign, widening of the duo sweep, elevation of hemidiaphram(s), effusion
- CT good for ruling out other causes, determining severity, and identify complications, if typical presentation and lab values support diagnosis routine CT is not needed
- ERCP if gallstones suspected
8
Q
Pancreatitis: complications
A
ARDS Renal failure shock encephalopathy hemorrhage
9
Q
Severe acute pancreatitis: defn
A
-presence of organ failure or local complications such as necrosis, abscess, pseudocyst
10
Q
Pancreatitis: severtiy
A
- Ranson criteria: done initially and at 48h
- APAHCE II: age, temp, MAP, HR, PaO2, pH, K, Na, Cr, Hct, WBC, GCS, health status
11
Q
Pancreatitis: tx
A
- fluids
- pain/nausea mgmt
- Abx if significant necrosis/abscess (Imipenem/meropenem or fluoroq + flagyl)
- ERCP for stones
- cholecystectomy w/in 6w if gallstone pancreatitis (not w/in first 2w)
- surgery if hemorrhage, bowel infarction, adbo compartment syndrome, perforation
12
Q
Cholecystitis
A
- inflammation of GB
- caused by impaired gb contraction (pregnancy, rapid wt loss, DM, TPN)
- diagnostic criteria: RUQ pain/murphy sign, fever/crp/wbc, GB wall >3mm, biliary duct >7mm diameter, pericholecystic fluid
- tx: CTX and flagyl, pain mgmt, or fluoroquinolong plus flagyl
- complications: cholangitis, emphysematous cholecystitis, gangrenous cholecystitis, pancreatitis
13
Q
Biliary colic
A
RUQ pain lasting 1-5h and remits spontaneously
-if pain >5h suspect cholecystitis, asc cholangitis, pancreatitis
14
Q
Acute acalculous cholecystitis
A
-RF: older age, critical illness, burns, trauma, major surgery, long term TPN, DM, immunosuppression
15
Q
GB perf
A
-occurs in 10% of pts with cholecystitis
