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29 Cards in this Set
- Front
- Back
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What four scoring systems are used to determine the severity of acute pancreatitis?
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Four scoring systems for acute pancreatitis:
1. Ranson's criteria 2. BISAP: Bedside Index in SevereAcute Pancreatitis 3. APACHE II score 4. CTSI (CT severity index) |
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What are the admission Ranson's criteria for alcoholic pancreatitis?
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Ranson's criteria on admission (etoh):
1. Age > 55 years old 2. WBC > 16 3. glucose > 200 mg/dL 4. AST > 250 IU/L 5. LDH >350 |
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What are the Ranson's criteria that occur over the first 48 hours after admission?
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Delayed Ranson's criteria:
1. Ca2+ < 8.0 mg/dL 2. PaO2 < 60 mmHg 3. rise in BUN of 5 mg/dL or greater 4. base deficit > 4 mEq/L 5. sequestration of > 6L fluid 6. hematocrit decrease > 10% |
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What is the relationship between Ranson's score and mortality?
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Relationship between Ranson's score and mortality:
1-2: 1% mortality 3-4: 15% mortality 5-6: 40% mortality |
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What are the initial therapies for acute pancreatitis?
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Initial therapy for acute pancreatitis:
1. fluid resuscitation with bilateral large bore access if hypotensive 2. NPO 3. analgesia with PCA or opioid 4. gastric decompression with NG Tube 5. NJ feeding tube 6. right upper quadrant ultrasound 7. Foley catheter |
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What are the common etiologies of acute pancreatitis?
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Etiologies of acute pancreatitis:
1. Gallstones (choledocholithiasis) 2. alcohol 3. hypertriglyceridemia 4. hypercalcemia 5. auto-immune disorder 6. ischemia-reperfusion 7. iatrogenic (ERCP) 8. congenital abnormalities 9. drug-induced |
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What parameters are used to determine the BISAP score?
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The BISAP score is determined by :
1. BUN > 25 mg/dL 2. Altered mental status 3. SIRS 4. Age > 60 years old 5. Pleural effusion |
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What BISAP score is indicatice of severe acure pancreatitis?
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A BISAP or 3 or more is indicative of severa cute pancreatitis.
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Elevation of what serum marker is predictive of progression to severe pancreatitis?
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elevation of serum C-reactive protein (> 150 ) is predictive of progression to severe acute pancreatitis.
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What are the common presenting signs and symptoms of acute pancreatitis?
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Presentation of acute pancreatitis:
1. midepigastric pain radiating to the back 2. nausea and vomitting 3. leukocytosis 4. tachycardia 5. low grade fever |
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How is the diagnosis of acute pancreatitis made?
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The diagnosis of pancreatitis is made by the combination of s/sx and elevated serum lipase.
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What serologies are performed in the initial evaluation of acute pancreatitis?
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Initial serologic evaluation for pancreatitis:
1. BMP: signs of dehydration, Ranson's criteria, glucose, base deficit 2. Calcium: ranson's criteria, possible etiology 3. LFTs: evidence of choledocholithiasis 4. CBC: leukocytosis, change over time 5. lipid panel: evaluate for hypertriglyceridemia 6. C-reactive protein |
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How is adequate resuscitation measured?
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Adequate resuscitation is determined by urine output with goal of atleast 0.5 cc/kg/hr. In the case of severe SIRS, adequate intravascular volume measure by CVP of 8 or CVP 12 in intubated patient. ScvO2 greater than 70%.
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What is your approach to patient who fails to improve with initial management?
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If pt fails to improve, then CT scan with pancreas protocol to evaluate for infected necrotizing pancreatitis.
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What is your approach to the management of sterile necrotizing pancreatitis?
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For sterile necrotizing pancreatitis, I allow for maturation of the process for 6 weeks as along as the patient remains clinically stable. This allows for complete demarcation of viable and non-viable tissue and for patient optimization.
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How is infected necrotizing pancreatitis diagnosed?
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The gold standard for diagnosis of infected necrotizing pancreatitis is cuture of fluid obtained by percutaneous fine needle aspiration of fluid content.
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What is your management of eary infected necrotizing pancreatitis?
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Step-up protocol: In early necrotizing pancreatitis, percutaneously drain infected collection. If pt does not stabilize or improve, then open necrosectomy.
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What is the differential diagnosis for patients with suspected acute pancreatitis?
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DDx for midepigastric pain:
1. gastric/duodenal ulcer 2. gastric/duodenal perforation 3. cholecystitis 4. cholangitis 5. small bowel obstruction 6. mesenteric ischemia 7. abdominal aortic aneurysm |
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What are the two major gaols of treatment of acute pancreatitis?
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The major goals of the treatment of pancreatitis:
1. Maximizing tissue perfusion 2. pain control |
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What parameters are used to assess the adequacy of resuscitation?
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Assessing the adequacy of resuscitation:
1. urine output > 0.5 mL/kg/hr 2. blood pressure 3. heart rate 4. central venous oxygen saturation 5. base deficit 6. lactic acid |
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Which antibiotics do you use as adjunct therapy for infected necrotizing pancreatitis?
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Antibiotics for infected necrotizing pancreatitis:
Vancomycin, imipenem, and fluconazole |
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What the admission Ranson's criteria for patients with biliary pancreatitis?
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Admission Ranson's criteria for biliary pancreatitis:
1. Age > 70 years 2. WBC > 18, 000 3. Glucose > 220 mg/dL 4. LDH > 400 IU/L 5. AST > 250 IU/L |
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What values are predictive of progression to severe pancreatitis?
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Values predictive of progression to severe pancreatitis:
1. Admission Ranson score of 3 or greater 2. APACHE-II score of 8 or greater 3. C-reactive protein of 150 mg/L or greater 4. CTSI of 3 or greater |
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Which serum values are predictive of biliary pancreatitis?
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ALT three times greater than normal or a total bilirubin twice the normal value has a posotive predictive value of 95% of gallstone pancreatitis as opposed to pancreatitis from ther causes.
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How is pancreatic necrosis identified on CT scan?
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During the arterial phase of a pancreatic protocl CT, areas of necrosis do not enhance, demonstrating Hounsefield unit < 30
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What is the Balthazar grading system for acute pancreatitis?
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Balthazar grading system is based on CT findings:
A: normal B: focal or diffuse enlargement of the pancreas, irregular contours, heterogenous attentuation C: B + peripancreatic inflammation D: C + one fluid collection E: C + two more fluid collections and/or the presence of gas |
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What two parameters are used to calculate the CT severity index?
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Two parameters of the CTSI:
1. Balthazar score 2. % necrosis |
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What is the most sensitive test for the diagnosis of choledocholithiasis?
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ERCP with EUS is the most sensitive test for diagnosing choledocholithiasis.
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How is pancreatic necrosis scored using the CT severity index?
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CTSI:
0: no necrosis 2: < 30% 4: 30-50 % 6: > 50% |
