Im Gi Pancreatitis Usmle 2

Front 1

what is the inflammation of the pancreas due to?
(2)

Back 1

- Autodigestion by proteolytic enzymes

- Systemic Inflammatory Response Syndrome (SIRS)
(severe cases)

Front 2

Exocrine (5) and Endocrine (3) secretions of the pancreas

Back 2

Exocrine:
Bicarbonate;
Amylase;
Lipase;
Tyrosine;
Proteases (trypsin, carboxypeptidase, etc)

Endocrine:
Glucagon;
Insulin;
Somatostatin

Front 3

(2) most common causes of pancreatitis

Back 3

Gallstones

Alcohol

Front 4

Dx:
patient w/ a hx of alcohol abuse has abdominal pain & calcifications on abd x-ray

Back 4

Chronic pancreatitis

Front 5

Etiology of Acute Pancreatitis
(7)

Back 5

G-HEADS:
Gallstones;
Hypertriglycerides; HyperC;
Endoscopic Retrograde Cholangiopancreatogrophy (ECRP);
Alcohol;
Drugs;
Structural (neoplasm)

Front 6

(4) drugs that can cause acute pancreatitis

Back 6

FEAT:
Furosemide;
Estrogen;
Antiretrovirals;
Thiazides

Hint 6

FEAT

Front 7

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

Back 7

Acute pancreatitis

Front 8

What is the most specific (and initial test) for Pancreatitis?

Most accurate?

If Pancreatic Necrosis is seen, what is the next step?

Back 8

most specific:
Lipase
(will be 2x normal)

most accurate:
CT scan

if necrosis: Pancreatic Bx

Front 9

Dx:
50-yo male alcoholic presents w/ mid epigastric pain radiating to the back. He is leading forward on the stretcher and vomiting

Back 9

Acute Pancreatitis

Front 10

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

Back 10

Acute Pancreatitis

Front 11

(4) Dx tests for pancreatitis

Back 11

Abdominal x-ray;
Ultrasound (gallstone cause);
ERCP (visualize sphinctor);
Contrast-Enhanced CT (shows pancreatic necrosis)

Front 12

Define:

Sentinel loop

what is it associated w/ in pancreatitis?

Back 12

Distention and/or air-fluid levels near a site of abdominal distention.

In pancreatitis, it is secondary to pancreatitis-associated Ileus

Front 13

Tx for acute Pancreatitis
(4 together)

Back 13

1. IV hydration;

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

3. Analgesics;

4. Antibiotics (Imipenem) for suspected infection

Front 14

What can occur in acute pancreatitis if left untreated in:
1. < 48 hours
2. 1 - 4 weeks
3. 4 - 6 weeks

Back 14

1. Pleural effusion of pancreatic fluids

2. Pseudocyst

3. Abscess (needs surgical drainage)

Front 15

What on a physical exam will indicate splenic vein thrombosis, a complication of pancreatitis?

Back 15

Gastric varices
(w/o esophageal varices)

Front 16

MCC of Chronic pancreatitis

Back 16

Alcohol abuse

Front 17

Dx:
midepigastric pain that radiates to the back; malabsorption; steatorrhea; elevated blood sugars; polyuria

Back 17

Chronic Pancreatitis

Front 18

the Secretin Stimulation test is used to Dx what (2) problems?

Back 18

1. Zollinger-Ellison syndrome

2. Chronic Pancreatitis

Front 19

*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"?

Back 19

Serum Trypsinogen

(which will be low)

Next step:
After Sudan Black confirms malabsorption and if Antigliadin and anti-endomysial Ab are normal.

Front 20

Describe the (2) signs of Hemorrhagic Pancreatitis:

1. Grey Turner's sign

2. Cullen's sign

Back 20

1. Ecchymotic appearing skin on the flank

2. same on the periumbilical area