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77 Cards in this Set
- Front
- Back
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acute inflammation of appendix |
appendicitis |
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most common cause of acute abdomen |
appendicitis |
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acute abdomen |
severe abdominal pain -surgical emergency |
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appendix is obstructed by (2) major things in appendix |
fecalith: in adults lymphoid hyperplasia in children |
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obstruction by: -tumor -parasites -foreign body -calculus |
appendicitis |
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increased mucoid secretions resulting in appendix obstruction |
appendicitis |
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appendicitis is a diseases affecting mainly who? |
YA & adolescents |
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pathogenesis of appendicitis |
-lumen of appendix gets obstructed by something such as lymphoid hyerplasia -wall behind the obstruction gets inflamed |
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periumbilical pain progressing to RLQ pain |
appendicitis |
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-fever -tachycardia -N/V -anorexia -diarrhea/constipation -severe abdominal pain |
appendicitis |
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appendicitis sx (6) |
-periumbilical pain progressing to RLQ pain -fever -tachycardia -N/V -anorexia -diarrhea/constipation |
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-guarding -rebound tenderness -peritonitis |
appendicitis |
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guarding |
when u try to press down on pt's abdomen, but they won't let you & their abdominal muscles tighten |
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rebound tenderness |
when u press down on RLQ, and let go suddenly, it's very painful for the pt |
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psoas sign |
used to dx appendicitis -extend pt's leg off table -press down on their knee -have them push knee up against R -produces pain in abdomen |
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obturator sign |
used to dx appendicitis -flex R hip and knee -IR leg -produces R hypogastric pain |
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Rosving's sign |
used to dx appendicitis -press down on LLQ -produces pain on RLQ |
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cutaneous hyperesthesia between T10-12 |
appendicitis |
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common complication of appendicitis |
periappendiceal abscess |
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reversible inflammation & hemorrhage of pancreas |
acute pancreatitis |
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auto digestion of pancreatic parenchyma by pancreatic enzymes |
acute pancreatitis |
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premature activation of trypsin leading to activation of other enzymes |
pathogenesis of acute pancreatitis |
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when are pancreatic enzymes usually activated? |
when they get to duodenum |
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which is the first pancreatic enzyme to get activated |
trypsin |
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2 most common causes of acute pancreatitis |
heavy alcohol use gallstones |
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how does alcohol cause acute pancreatitis |
it causes contraction of the sphincter of Oddi - at the ampulla of the duodenum -this blocks drainage of pancreatic enzymes --> stays w/in pancreas --> increases risk of premature activation of P enzymes |
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how do gallstones cause acute pancreatitis |
gallstone can block ampulla of duodenum --> this blocks drainage of pancreatic enzymes --> they stay w/in pancreas --> increases risk of premature activation of P enzymes |
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all causes of acute pancreatitis GET SMASHED |
gallstones ethanol trauma steroids memps autoimmune disease scorpion stings hyper-calcemia; hyper-triglyceridemia ERCP |
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when does acute pancreatitis incidence increase? |
as ppl age |
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males or females more commonly affected by acute pancreatitis |
males |
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necrotizing pancreatitis |
liquefactive necrosis w/ extensive hemorrhage |
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edematous pancreatitis |
fat necrosis of peripancreatic fat |
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fat necrosis of peripancreatic fat |
when pancreatic enzymes digest the fat surrounding the pancreas --> forms fatty acids which undergo saponification = necrosis |
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-epigastric pain radiating to back -pain: boring/constant; sometimes improved by leaning forward -rapidly escalates in intensity -dyspnea secondary to diaphragmatic splinting secondary to pain -N/V -periumbilical & flank hemorrhage |
acute pancreatitis |
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signs: -pallor -diaphoresis -tender upper abdomen -fever: 101-103F -distention of abdomen -ileus -initial HTN -guarding/rebound tenderness |
acute pancreatitis |
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grey-turner's sign |
flank ecchymosis |
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cullen's sign |
periumbilical ecchymosis |
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shallow respirations secondary to diaphragmatic splinting secondary to pain |
acute pancreatitis |
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-hypotension occur secondary to third space fluid losses (hypovolemia) -increased HR -percussion tenderness -fever -tender upper abdomen -cullen's & grey-turner's signs |
acute pancreatitis |
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dx of acute pancreatitis |
-serum amylase/lipase -fasting serum glucose -CBC -serum Ca2+ -liver function tests -plain abdominal/CXR -abdomen US/CT |
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when dx acute pancreatitis, what can pancreatic enzyme levels tell u vs. glucose levels? |
PE: tell u that there is damage at the level of pancreas G: tell u the extent of pancreatic damage --> if parenchyma containing islets cells are damaged |
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fluid collections of necrotic debris, pancreatic enzymes, & granulation tissue surrounded by fibrous tissue w/ no true epithelial lining |
pancreatic pseudocyst |
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why is a pancreatic pseudocyst called a pseudocyst |
b/c it lacks a true epithelial lining |
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palpable abdominal mass w persistent amylase levels |
pancreatic pseudocyst |
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fibrous tissue surrounding liquefactive necrosis & pancreatic enzymes |
pancreatic pseudocyst |
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most common complication of acute pancreatitis |
pancreatic pseudocyst |
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danger of having a pancreatic pseudocyst |
it can rupture, release all PE into abdomen, cause hemorrhage |
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DIC -what is it -what disease can it occur in? |
disseminated intravascular coagulation -a condition whereby all clotting factors are used up, causing massive clotting in all small blood vessels of body --> PE can activate them -acute pancreatitis |
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ARDS -what is it -what disease can it occur in? |
acute respiratory distress syndrome -fluid buildup in alveoli causing inability for O2 to get into capillaries --> O2-deprivation of organs -PE disrupt alveolar-capillary interface -acute pancreatitis |
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Ranson criteria |
clinical predicting rule for predicting severity of acute pancreatitis |
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tx for acute pancreatitis |
-IV fluids/electrolytes -Nothing by mouth --> parenteral nutrition -bowel rest -antibiotics if there is infection -analgesia: tx pain -surgery if obstruction present |
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fibrosis of pancreatic parenchyma that is irreversible |
chronic pancreatitis |
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fibrosis of pancreatic parenchyma (aka ______) occurs secondary to ? |
chronic pancreatitis --> recurrent bouts of acute pancreatitis |
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most common cause of chronic pancreatitis |
long standing alcohol abuse |
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2 main causes of chronic pancreatitis |
-alcohol abuse -CF in children |
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triad of ____: -steatorrhea -secondary DM -pancreatic calcification |
chronic pancreatitis |
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pancreatic insufficiency: -what is it -what is it a key complication of? |
-when pancreas doesn't make the digestive enzymes it's supposed to -chronic pancreatitis |
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pancreatic insufficiency is AKA? |
exocrine insufficiency |
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why does malabsorption & steatorrhea occur in chronic pancreatitis |
b/c if the pancreas doesn't make its digestive enzymes, then fat can't be digested and then absorbed |
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can see these 3 together in _____ -fat soluble vitamin deficiencies -malabsorption -steatorrhea |
chronic pancreatitis |
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are amylase/lipase useful dx markers for chronic pancreatitis |
no- pancreas isn't making them at this point so wouldn't see any increased levels |
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why do u see pancreatic calcification in chronic pancreatitis |
when PE digest fat, fatty acids are released, undergo saponification, then can combine w/ Ca2+ to from insoluble salts --> deposit in pancreas |
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-obstruction of main pancreatic duct -loss/destruction of exocrine parenchyma -calcification -fibrosis -later stages: loss of endocrine parenchyma |
chronic pancreatitis |
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-epigastric abdominal pain radiating to back -steatorrhea -malabsorption -increased risk for pancreatic carcinoma -secondary SM |
chronic pancreatitis |
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in chronic pancreatitis, u get increased risk for ____ |
pancreatic carcinoma |
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adenocarcinoma arising from pancreatic ducts |
pancreatic carcinoma |
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pancreatic carcinoma seen mostly in who? |
elderly - 60-80 y/o |
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major risk factors for pancreatic carcinoma |
-smoking -chronic pancreatitis -diets high in fat or red meats -surgical hx of partial gastrectomy or cholecystectomy -genetic predisposition: k-ras or p53 genes |
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most lesions of pancreatic carcinoma occur where in pancreas? |
head |
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-insidious onset; pts present late in disease course -initially asymptomatic -epigastric abdominal pain - radiates to back -weight loss, anorexia, malaise, weakness, nausea -diarrhea, malabsorption, depression -secondary DM or obstructive jaundice, pale stools, & palpable gallbladder -pancreatitis |
pancreatic carcinoma |
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elderly person who develops DM |
pancreatic carcinoma |
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Trousseau syndrome -what is it? -what is it seen in? |
migratory thrombophlebitis: redness or tenderness in extremities --> indicates malignancy esp. of pancreas |
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CA 19-9 |
serum marker seen in pancreatic carcinoma |
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carcinoembryonic antigen |
serum marker seen in pancreatic carcinoma |
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tx for pancreatic carcinoma |
whipple procedure: surgical removal of pancreatic neck/head, proximal duodenum, GB -chemotherapy/ radiation |
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complications for pancreatic carcinoma |
vascular & lymphatic metastasis |
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prevention of pancreatic carcinoma |
diet modification; stop smoking |
