Severe Upper Abdo Pain Flashcards

1
Q

What causes abdominal pain and hypotension?

A

Acute Pancreatitis

Perforated peptic ulcer

Ruptured AAA

Ectopic pregnancy

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2
Q

How is the diagnosis of pancreatitis made?

A

2/3 of the following:

Abdominal pain

3x normal lipase

CT findings of pancreatitis

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3
Q

What are the most sensitive enzymes for gall stones in the setting of pancreatitis?

A

ALT and AST

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4
Q

How do gall stones cause pancreatitis?

A

Stone in the common bile duct - not fully understood

  • either blockage of pancreatic duct or reflux of duodenal fluid
  • end point is stasis of trypsinogen in the pancrease which is activated into trypsin
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5
Q

Outline how pancreatitis is characterised?

A

Mild - no organ failure

Moderate - Limited organ failure

Severe - Multi organ failure

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6
Q

What is a useful test to assess pancreatitis severity?

A

CRP at 48 hours - >150 is severe

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7
Q

What is the best scoring system for pancreatitis severity in our patient population?

A

Modified Glasgow

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8
Q

What did the SAFE trial show?

A

That albumin and saline are equivalent for resuscitation

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9
Q

What is the normal urine output?

A

0.5-1ml/kg/hour

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10
Q

What are some acute complications of acute pancreatitis?

A

SIRS = Hypoxia or Renal failure/impairment

Cholangitis

Necrotising pancreatitis

Hospital acquired infection secondary to atelectasis

L Colon infarction

Walled off necrosis

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11
Q

When should an ERCP be performed in pancreatitis?

A

If cholangitis develops

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12
Q

What are the hallmarks of SIRS?

A

Temperature -

RR - >20

Tachycardia - >

WBC -

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13
Q

What is MODS?

A

Multiple organ dysfunction syndrome

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14
Q

What blood markers can be used to differentiate sepsis from SIRS

A

Pro-calcitonin

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15
Q

What is a simple formula for PaO2 on oxygen supplementation?

A

FiO2 x 5

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16
Q

What does CPAP and BIPAP stand for? When are they indicated?

A

Continuous positive airways pressure

Bi-level positive airways pressure - adds some inspiratory pressure to help ventilate

To help ventilation (not gas exchange)

17
Q

When are IV abx indicated in pancreatitis? Which abx is used?

A

Cholangitis

Infected necrotising pancreatitis

Meropenem

18
Q

When (time wish) does infected pancreatitis occur?

A

1-3 weeks later

19
Q

What type of feeding replacement is best in pancreatitis?

A

NG

20
Q

What is the most common yeast and mould?

A

Yeast - Candida

Mould - Aspergillus

21
Q

What are some risk factors for yeast infections?

A

Immunosuppression

Intra-abdominal surgery

Lines

TPN

Malnutrition

Blood transfusions

22
Q

Pancreatitis + biliary colic = ???

A

Cholecystectomy