Uw revision acute pancreatitis 03-05 (2)

Question 1

When occurs lipase?

Answer 1

Lipase: within 4-8h of symptoms, remains 8-14 days

Question 2

When occurs amylase?

Answer 2

Amylase: within 6-12h, remains 3-5days.

Question 3

when abdomen CT?

Answer 3

Imaging typically not required for Dx (if symptoms and labs are significant). Contrast CT may be performed if Dx unclear or no response to treatment (to identify necrosis or infection).

Question 4

We have symptoms. no labs or CT. next step?

Answer 4

take labs!! just then CT if needed

Question 5

Pancreas synthesize digestive enzymes, but cannot secrete them. They leak out into systemic circulation.

Answer 5

.

Question 6

Which marker for late pancreatitis?

Answer 6

lipase. remains highs up to 14d.

Question 7

What is needed for Dx?

Answer 7

To Dx acute pancreatitis need 2 of 3: pain radiating to back, incr. amylase/lipase 3 times normal limit, abdominal CT.

Question 8

Etiology of acute?

Answer 8

Chronic alcohol use
Gallstones
Hyperlipidemia (types I, II, IV)
Drugs (didanosine, azatiophrine, valproic acid)
Infection (CMV, legionella, aspergillus)
Trauma
Iatrogenic (post-ERCP)

Question 9

CP other findings?

Answer 9

Nausea, vomiting, leukocytosis
Severe disease possible abdominal tenderness, fever, tachypnea, hypoxemia, hypotension
ALT level > 150 –> biliary pancreatitis

Question 10

what says ALT >150?

Answer 10

biliary pancreatitis

Question 11

Complications?4

Answer 11

Pleural effusions
Ileus
Pancreatic pseudocyst/abscess/necrosis
ARDS

Question 12

when ERCP?

Answer 12

not for initial diagnosis.

useful if biliary pancreatitis OR to evaluate patients with recurrent pancreatitis or draining pancreatic pseudocysts

Question 13

DRUGS THAT CAUSE PANCREATITIS. Diuretics? 2

Answer 13

Furosemide, thiazides

Question 14

DRUGS THAT CAUSE PANCREATITIS. drugs for IBD? 2

Answer 14

sulfasalazine, 5-ASA

Question 15

DRUGS THAT CAUSE PANCREATITIS. Immunosupressive? 3

Answer 15

Azathioprine, mercaptopurine
Corticosteroids

Question 16

DRUGS THAT CAUSE PANCREATITIS.
Antivirals HIV? 3

Answer 16

Didanosine, pentamidine, lamivudine

Question 17

DRUGS THAT CAUSE PANCREATITIS. Abs? 4

Answer 17

metronidazole
tetracycline
isoniazide
TMP-SMX

Question 18

DRUGS THAT CAUSE PANCREATITIS. Antiepileptics? 2

Answer 18

Valproic acid
Carbamazepine

Question 19

DRUGS THAT CAUSE PANCREATITIS. antihypertensive? 4
+ 1?

Answer 19

Thiazides, furosemide (buvo prie diuretiku) - have sulfonamide group –> triggers hypersensitivity –> pancreatitis

Enalapril, losartan

+ statins

Question 20

DRUGS THAT CAUSE PANCREATITIS. analgetics? 4

Answer 20

Acetaminophen
NSAIDs
mesalamine, sulfasalazine (buvo prie IBD)
Opiates

Question 21

DRUGS THAT CAUSE PANCREATITIS. Others?2

Answer 21

Asparaginase
Estrogens

Question 22

When hyperTG cause pancreatitis?

Answer 22

> 1000 mg/dl

Question 23

What Tx of drugs induced pancreatitis?

Answer 23

discontinue offending drug + same as in any other pancreatitis

Question 24

Dar egzistuoja toks dalykas kaip autoimuninis pankreatitas. Kas sukelia? tx?

Answer 24

Rare
IgG4 mediated.
Dx confirmation: Pancreas biopsy in addition to a serum IgG4 level.
Don give drugs prior confirmation.
Drugs to Tx: Glucocorticoids

Question 25

severe pancreatitis table. CP?

Answer 25

fever, tachy, hypotension
dyspnea, tachypnea, basilar crackles
abdominal tenderness and distension
Cullen sign - periumbilical bluish discoloration indicating HEMOperitoneum
Grey Turner sign: reddish-brown coloration around flanks indicating RETROperitoneal bleed

Question 26

severe pancreatitis table. assoc risk factors?

Answer 26

Age > 75
obesity
alcoholism
CRP >150 at 48h after presentation
rising BUN and Cr in first 48h
Xray - pulmonary infiltrates or pleural effusion
CT/MRCP - pancreatic necrosis and extra pancreatic inflammation

Question 27

severe pancreatitis table. complications?

Answer 27

Pseudocysts (takes 3-4 weeks)
Peripancreatic fluid collection
Necrotizinf pancreatitis
ARDS
Acute renal failure
GI bleeding