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what is the inflammation of the pancreas due to?
(2)
- Autodigestion by proteolytic enzymes

- Systemic Inflammatory Response Syndrome (SIRS)
(severe cases)
Exocrine (5) and Endocrine (3) secretions of the pancreas
Exocrine:
Bicarbonate;
Amylase;
Lipase;
Tyrosine;
Proteases (trypsin, carboxypeptidase, etc)

Endocrine:
Glucagon;
Insulin;
Somatostatin
(2) most common causes of pancreatitis
Gallstones

Alcohol
Dx:
patient w/ a hx of alcohol abuse has abdominal pain & calcifications on abd x-ray
Chronic pancreatitis
Etiology of Acute Pancreatitis
(7)
G-HEADS:
Gallstones;
Hypertriglycerides; HyperC;
Endoscopic Retrograde Cholangiopancreatogrophy (ECRP);
Alcohol;
Drugs;
Structural (neoplasm)
(4) drugs that can cause acute pancreatitis
FEAT:
Furosemide;
Estrogen;
Antiretrovirals;
Thiazides
FEAT
Dx:
constant mid-epigastric or LUQ pain that radiates to the back; may improve if patient sits-up and leans forward. N/V, fever, tachypnea, abd is tender w/ guarding
Acute pancreatitis
What is the most specific (and initial test) for Pancreatitis?

Most accurate?

If Pancreatic Necrosis is seen, what is the next step?
most specific:
Lipase
(will be 2x normal)

most accurate:
CT scan

if necrosis: Pancreatic Bx
Dx:
50-yo male alcoholic presents w/ mid epigastric pain radiating to the back. He is leading forward on the stretcher and vomiting
Acute Pancreatitis
Dx:
a 66-yo female w/ HTN and seziures is on furosemide and valproic acid, presents w/ abdominal pain, back pain and fever. Her non-fasting glucose is 300
Acute Pancreatitis
(4) Dx tests for pancreatitis
Abdominal x-ray;
Ultrasound (gallstone cause);
ERCP (visualize sphinctor);
Contrast-Enhanced CT (shows pancreatic necrosis)
Define:

Sentinel loop

what is it associated w/ in pancreatitis?
Distention and/or air-fluid levels near a site of abdominal distention.

In pancreatitis, it is secondary to pancreatitis-associated Ileus
Tx for acute Pancreatitis
(4 together)
1. IV hydration;

2. Bowel rest - Antiemetics
(NG tube for vomiting or associated ileus);

3. Analgesics;

4. Antibiotics (Imipenem) for suspected infection
What can occur in acute pancreatitis if left untreated in:
1. < 48 hours
2. 1 - 4 weeks
3. 4 - 6 weeks
1. Pleural effusion of pancreatic fluids

2. Pseudocyst

3. Abscess (needs surgical drainage)
What on a physical exam will indicate splenic vein thrombosis, a complication of pancreatitis?
Gastric varices
(w/o esophageal varices)
MCC of Chronic pancreatitis
Alcohol abuse
Dx:
midepigastric pain that radiates to the back; malabsorption; steatorrhea; elevated blood sugars; polyuria
Chronic Pancreatitis
the Secretin Stimulation test is used to Dx what (2) problems?
1. Zollinger-Ellison syndrome

2. Chronic Pancreatitis
*What is the only test that is specific for a Dx of Chronic Pancreatitis from the Sx of Steatorrhea?

When is it the "Next step"?
Serum Trypsinogen

(which will be low)

Next step:
After Sudan Black confirms malabsorption and if Antigliadin and anti-endomysial Ab are normal.
Describe the (2) signs of Hemorrhagic Pancreatitis:

1. Grey Turner's sign

2. Cullen's sign
1. Ecchymotic appearing skin on the flank

2. same on the periumbilical area