Severe Upper Abdo Pain

Question 1

2 out of 3 findings needed for pancreatitis

Answer 1

abdo pain
lipase
CT findings

Question 2

most sensitive LFTs for gall stones?

Answer 2

ALT

AST

Question 3

what do you need to see on RUQ ultrasound

Answer 3

bile duct 4-5mm

gall bladder wall thickness

Question 4

how does gallstones cause pancreatitis?

Answer 4

autoactivation/digestion of pancreas from it’s own enzymes

Question 5

pancreatitis characterised how?

Answer 5

mild - no organ failure
mod - transient organ failure
Severe- persistant organ failure

Question 6

useful blood test for pancreatitis to characteritics?

Answer 6

CRP, if over 150 or 200, mod, severe.

Question 7

good scoring system for pancreatitis?

Answer 7

modified glasgow

Question 8

only thing to modify outcome in severe pancreatitis?

Answer 8

ICU - for lots of fluids

Question 9

normal urine output?

Answer 9

0.5ml/kg/hour

Question 10

abdo structures that can be damaged by pancreatitis?

Answer 10

left colon

Question 11

if they have cholangitis from gall stone, how to treat early with?

Answer 11

ERCP

Question 12

early complications of acute pancreatitis?

Answer 12

SIRS - hypoxia, renal failure

Question 13

SIRS is:

Answer 13

temp (>38)
WBC (high or low)
tachy (>10
RR (>20)

Question 14

SIRS vs. sepsis?

Answer 14

SIRS is non-infectious

Question 15

MODS is?

Answer 15

multi-organ dysfunction syndrome

Question 16

blood tests for sepsis?

Answer 16

procalcitonin

Question 17

if getting Fi02, what is p02 should be?

Answer 17

Fi02 times 5

Question 18

non-invasive ventilation are?

Answer 18

BIPAP - bi-level to force air INTO lung

CPAP -continuous positive pressure both ways

Question 19

non-invasive good for what kind of respiratory failure?

Answer 19

Type 2, more for ventilatory

Question 20

acute complications of pancreatitis on CT?

Answer 20

pancreatic necrosis
infected
fluid collections (becomes pseudocyst)
Walled off fluid

left colon infarct
splenic vein thrombosis?

Question 21

Abx for pancreatitis?

Answer 21

only if has cholangitis

or infective necrosis

Question 22

what ABx for pancreatitis if you use them?

Answer 22

meropenem

Question 23

enteral or TPN better for pancreatitis?

Answer 23

enteral

Question 24

most common yeast and mould?

Answer 24

yeast - candida

mould - aspergillus

Question 25

risk factors for invasive candida

Answer 25

``` surgery immunosuppression ICU admission invasive lines TPN malnutrition blood transfusions ```

Question 26

abdo pain + hypotension

Answer 26

pancreatitis perforated peptic ulcer AAA