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23 Cards in this Set

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What are common causes of acute pancreatitis?
1. alcohol
2. gallstones
What are uncommon causes of pancreatitis?
1. Drugs (ddI, ddC, d4T, sulfonamides, tetracycline, thiazides, pentamidine, azathioprine, estrogen, valproate)
2. Viral
3. Triglycerides greater than 1000
4. Idiopathic
5. Trauma
6. Hypercalcemia
Pancreatitis can become ______ if the underlying cause is not treated.
Pancreatitis can become CHRONIC if the underlying cause is not treated.
In pancreatitis, patients report severe steady ________ pain, oftening radiating to the _______, worse lying down, and relieved sitting up.
In pancreatitis, patients report severe steady EPIGASTRIC pain, oftening radiating to the BACK, worse lying down, and relieved sitting up.
Nausea and vomiting are common in pancreatitis, and are exacerbated by _______.
Nausea and vomiting are common in pancreatitis, and are exacerbated by EATING.
If pancreatic edema or gallstones occlude the common bile duct, ___________ ensues.
If pancreatic edema or gallstones occlude the common bile duct, JAUNDICE ensues.
What do I look for on physical exam?
Look for:
1. tachycardia
2. hypotension
3. volume depletion due to third spacing of fluids
4. low-grade fever due to inflammation or infection.
5. the abdomen is usual diffusely tender
Retroperitoneal pancreatic hemorrhage may manifest as bruising around _______ or _______, although both these signs are rarely seen.
Retroperitoneal pancreatic hemorrhage may manifest as bruising around UMBILICUS (CULLEN'S SIGN) or FLANK (TURNER'S SIGN), although both these signs are rarely seen.
What tests should I order?
Order the following:
1. CBC
2. Amylase or lipase
3. Chem panel
4. Calcium
5. Liver function
6. LDH
7. Glucose
8. Triglycerides
9. Xrays of the abdomen and chest
Pancreatic calcifications on x-ray are pathognomonic of ___________.
Pancreatic calcifications on x-ray are pathognomonic of CHRONIC PANCREATITIS.
In pancreatitis, CXR may show ___________.
In pancreatitis, CXR may show PLEURAL EFFUSION.
Abdominal CT scan may show necrotic pancreatic tissue, an indication for ____________.
Abdominal CT scan may show necrotic pancreatic tissue, an indication for ANTIBIOTIC PROPHYLAXIS.
If patients are refractory to therapy, repeat abdominal CT scan may show developing complications such as pancreatic pseudocyst or abscess. Follow CBC, calcium, BUN, PaO2 and base deficity from arterial blood gas to assess worsening prognosis by __________.
Ranson criteria, which predict mortality rates.

Mortality is 2% with 0-2 criteria, 40% with 5-6 criteria, nearly 100% with 7+ criteria.
What is included in the Ranson criteria?
Initial evaluation:
Age greater than 50
WBC greater than 16,000
SGOT (AST) greater than 250
LDH greater than 350
Glucose greater than 200

Changes in the first 48 hours:
HCT drop greater than 10%
BUN rise greater than 5 mg/dL
Ca less than 8
PaO2 less than 60
Base deficit greater than 4
Treatment is mostly supportive, such as resting the bowel, allowing inflammation to subside, and treating complications. Use bowel rest meaning __________ and IV fluids _________ as needed for resuscitation and then maintenance fluids ______________.
Use bowel rest meaning NOTHING TO EAT and IV fluids NORMAL SALINE as needed for resuscitation and then maintenance fluids D5 1/4 NORMAL SALINE.
Place a nasogastric tube to low-intermitten suction if _________ is present.
Place a nasogastric tube to low-intermitten suction if VOMITING is present.
ERCP relieves an obstructing gallstone, but may worsen ___________.
ERCP relieves an obstructing gallstone, but may worsen PANCREATIC INFLAMMATION.
Manage pain with __________.
Manage pain with PATIENT-CONTROLLED IV NARCOTICS.
Watch for complications of pseudocyst, abscess, sepsis and ___________.
Watch for complications of pseudocyst, abscess, sepsis and ARDS.
Severely ill patients and those with necrotic pancreatic tissue on CT scan may benefit from prophylaxis with broad-spectrum antiobiotics such as ________ or __________.
Severely ill patients and those with necrotic pancreatic tissue on CT scan may benefit from prophylaxis with broad-spectrum antiobiotics such as IMIPENEM or CEFUROXIME.
Follow daily amylase, liver function tests, and CBC until they return to normal to track resolution of ____________.
Follow daily amylase, liver function tests, and CBC until they return to normal to track resolution of INFLAMMATION.
Refer for _________ when the pancreatitis resolves if stones were the cause.
Refer for ELECTIVE CHOLECYSTECTOMY when the pancreatitis resolves if stones were the cause.
Mortality is _____ % overall in patients hospitalized with pancreatits.
Mortality is 10% overall in patients hospitalized with pancreatits.