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42 Cards in this Set
- Front
- Back
identify the 2 classifications of acute pancreatitis |
1. Interstitial (edematous): most common, milder, NO acinar cell death 2. Necrotizing: less common (15-20%), severe, most mortalities |
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signs and symptoms of acute pancreatitis |
Epigastric pain** (Hallmark: feels like a knife is in their belly), N/V Anorexia Severe cases “shocky” |
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trypsinogen is activated by ..... |
cathepsin B |
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pancreatic enzymes without pro-enzyme form |
amylase lipase |
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2 most common causes of pacreatitis |
alcohol gallstones |
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elevated IgG4 |
autoimmune pancreatitis |
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sausage shaped pancreas |
autoimmune pancreatitis |
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1. most specific serological marker for acute pancreatitis 2. drug that can give you a false positive |
1. Lipase (3X uln) 2. heparin |
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best serological marker for prognosis |
BUN >20 = intravascular depletion |
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how to differentiate macroamylassemia from acute pancreatitis |
they both have elevated serum amylase look at the urine amylase:creatinine ratio: 1. macroamylasemia: close to 0 2. acute pancreatitis: elevated |
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PRSS1 |
autoimmune pancreatitis |
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#1 cause of chronic pancreatitis |
alcohol increases viscosity of pancreatic secretions, causes sphincter of Oddi spasm, loss of R protein |
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most sensitive and specific test for chronic pancreatitis |
fecal elastase early phases of pancreatic insufficiency <200 = pancreatic insufficiency |
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pancreatic calcifications on x-ray |
confirmatory diagnosis for chronic pancreatitis |
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two things you see in chronic pancreatitis but not acute pancreatitis |
statorrhea diabetes mellitus |
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Pancreatic Enzyme Replacement for chronic pancreatitis: 1. non-enteric coated - what does it treat? - what do you give with it? 2. enteric coated - what does it treat? |
1. non-enteric coated - pain (high in peptidase) - antacids (PPI) 2. enteric coated - steatorrhea (high in lipase) |
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most important factor for gallstone formation |
gallbladder stasis |
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charcot's triad |
cholangitis 1. fever 2. pain 3. jaundice |
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reynold's pentad |
charcot's triad +: 4. shock 5. encephalopathy |
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who get's gallstones the most |
PIMA indian women |
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how would you test for gallbladder disease? |
Ultrasound 1st (gallstone --> you’ll see Post-acoustic shadowing) THEN CCK simulated HIDA Scan (but do not stimulate with CCK if there are known gallbladder stones!!!!) won't see on x-ray because gallstones are radioluscent |
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Black Pigment stones: |
increased unconjugated bilirubin, most commonly due to Hemolysis Mostly salt of unconjugated bilirubin |
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Brown Pigment Stones: |
Due to infection (3rd world country) Contain calcium bilirubinate, calcium palmitate, mucin, biliary epithelia, and cholesterol Bacterial cell bodies are seen at the core |
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prognosis for pancreatic adenocarcinoma (exocrine tumor) |
Overall 5 year survival: 3-5% LOWEST OF ALL CANCERS!! |
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diagnosis of insulinoma |
Hypoglycemia + elevated insulin with pancreas mass. 72 hour fast: if Insulin/glucose > 0.3 = insulinoma! Tumor of Beta islet cell Symptoms: HA, confusion,light-headness, visual sx’s, irrational behavior, drowsiness, coma |
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diagnosis of VIPoma |
Secretory diarrhea + increased serum VIP Symptoms: fasting large volume diarrhea (>3L/day), hypokalemia, hypochlorohydria, flushing |
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diagnosis of GRFoma |
Acromegaly + increased growth hormone level +pancreatic mass |
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diagnosis of glucagonoma |
tumor of alpha islet cells increased serum glucagon >1000pg/ml + pancreatic mass dermatitis ***Necrolytic migratory erythema***, glucose intolerance, weight loss, anemia,chronic diarrhea Tx: octreotide/ surgery |
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what is a klatskin tumor symptoms? how do they die? Tx? |
Cholangiocarcinoma at junction of left and right intrahepatic ducts. PAINLESS Jaundice. Die of hepatic failure or cholangitis. TX: resection (hepatojejunostomy) |
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acute pancreatitis with: ALT > 3X ULN |
gallstone pancreatitis |
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acute pancreatitis with: CRP > 150 |
severe acute pancreatitis |
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how do you diagnose acute pancreatitis |
2 out of 3: 1. characteristic epigastric pain radiating to back (knife stabbed through them) 2. + CT findings 3. lipase >3X ULN |
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treatment of acute pancreatitis |
mostly supportive: FLUIDS!!! (monitor BUN closely) naso-jejunal feeding tube (don't give antibiotics if they only have interstitial [do give for necrotizing, biliary obstruction or abscess?]) narcotics may worsen ileus |
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pancreaticpseudocyst VS. acute peripancreatic fluid collection |
Timing is KEY: pseudocyst: 4-6 weeks after acute episode acute peripancreatic fluid collection: shortly after acute episode |
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treatment of chronic pancreatitis |
1. diet (low fat, small meals) 2. pancreatic enzyme replacement 3. chronic pain control (stop drinking and smoking) |
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when should you do a cholecystectomy for gallbladder disease patients that could potentially have cancer? |
any PSC pt with a polyp any polyp > 1cm porcelain gallbladder Adenocarcinoma (radical cholecystectomy,right lobectomy, trisegmentectomy) |
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gallbladder adenocarcinoma: diagnosis symptoms treatment |
(most common GB cancer) Diagnosis: - Increased ALP/Bilirubin. - CEA/ CA 19-9 may be elevated. Symptoms: Pain is initial complaint, hepatomegaly, palpable mass, ascites. Jaundice, malignant cholecysto-enteric fistula Treatment: - 80% have unresectable tumors. 1-6% 5 year survival. - Surgery: radical cholecystectomy, right lobectomy, trisegmentectomy. - Chemo/XRT NOT helpfl |
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diagnosis of pancreatic adenocarcinoma |
no calcification in ductal adenocarcinoma (seeing calcification is good because it means it's not ductal) 85% have increase CEA level CA19-9 may be useful to follow tumor? and most commonly associated with pancreatic cancer? |
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Insulinoma: insulin:glucose > ___?___ |
0.3 |
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necrolytic migratory erythema |
glucagonoma |
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pancreatic tumor with acromegaly |
GRFoma |
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pancreatic tumor with secretory diarrhea |
VIPoma |