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30 Cards in this Set

  • Front
  • Back
What cells of the pancreas are endocrine cells?
Islets of langerhans:

alpha cells: glucagon
beta cells: insulin
delta cells: somatostatin
What cells of the pancreas are exocrine cells?
centroacinar cells - HCO3-
basophilic cells
What are some rare acute pancreatitis etiologies?
scorpion sting
hereditary (trypsinogen mediated)
cystic fibrosis
What are some rare obstructive reasons for acute pancreatitis?
ampullary, pancreatic tumors and pancreatic divism
What are some rare metabolic reasons for acute pancreatitis?
HyperTGA and HyperCa++
What are some rare Drug related-reasons for acute pancreatitis?
furosemide, thiazide, sulfa, protease inhibitors, estrogen and asothiaprine
What are some rare infection related reasons for acute pancreatitis?
Coxsackie virus
What are some common reasons for acute pancreatitis?
What does the physical exam find with pancreatitis?
abdominal tenderness, guarding
Pt sometimes restless (knee-chest position)
decreased bowel sounds
palpable abdominal mass (pseudocyst?)
Cullen's sign or Grey Turner's sign (retroperitoneal hemorrhage)
hypotension, fever, shock
respiratory distress
basilar lung crackles if pleural effusion present
What will a pt with pancreatitis present with?
fever, chills, nausea, vomiting, abdominal distention

mid-epigastric abdominal pain (radiates to the back--sometimes better sitting forward)
What is on your differential diagnosis when evaluating a pt with pancreatitis
acute/chronic alcohol consumption
gallstone disease
PUD or perforated ulcer
early appendicits
bowel obstruction, mesenteric ischemia
gastritis Vs. GERD
pulmonary, renal or cardiovascular disorders
What labs do you need to order to diagnosis acute pancreatitis?
CBC (increased WBC, decreased H/H is hemorrhage is present)

Electrolytes (increased BUN, Decreased Ca++)
increased glucose
elevated CRP/ESR
+/- LET's or Bilirubin
increased amylase, lipase
When doing an imaging study, which one would you chose to see if the pt has acute pancreatitis?
abdominal CT--may appear normal (30%): looking for necrosis, pseudocyst, calcifications, gallstones?

Abdominal US: gallstones, common duct dilation
ERCP (endoscopic retrograde cholangiopancreatography)
How is Mild pancreatitis defined?
Ranson < 3
CT index <7
How is Severe pancreatitis defined?
Ranson > 3
CT index > 7
What are the three ways to assess prognosis with pancreatitis?
Ranson's criteria
CT severity index (CT grade + necrosis score)
What is the scoring for Ranson's criteria at admission?
1 - age > 55yo
2 - WBC > 16,000/ul
3 - blood glucose > 200mg/dl
4 - Serum LDH > 350
5 - SGOT (AST) > 250
What is the scoring for Ranson's criteria at 48hrs?
1 - hematocrite >10%
2 - BUN > 8mg/dl
3 - serum Ca > 8mg/dl
4 - arterial O2 saturation<60mmHG
5 - base deficit > 4meq/L
6 - estimated fluid sequestration > 6L
How does the total scoring for Ranson's criteria match the mortality level?
less than or equal to 2 = <5%
3-4 = 15-20% mortality
5-6 = 40% mortality
greater than or equal to 7 = 99% mortality
What is included in the APACHE II equation?
Rectal temperature
heart rate
arterial pH
serum K+, Na+, creatine
hematocrit, WBC
Glasgo Coma Scale score
Chronic health status
With the CT severity index, how is CT grade scored?
A-normal pancreas (0)
B-endematous pancreas (1)
C-"B" + mild extra pancreatic changes (2)
D-severe extra pancreatic changes + one fluid collection (3)
E-multiple/extensive fluid collections(4)
What is the necrosis scoring in the CT severity index?
<1/3 (2points)
1/3, but <1/2 (4points)
1/2 (6points)
What is the treatment for pancreatitis?
rest the pancreas (NPO, NG) and give supportive care
What is supportive care for a pancreatitis?
fluids (may need up to 10L for severe pancreatitis with hemodynamic instability)
pain control
antibiotics if evidence of necrosis
insulin for severe hyperglycemia
nutritional support when indicated
ERCP if gallstone pancreatitis with biliary obstruction
ICU if hemodynamically unstable
What are some complications of pancreatitis?
shock, ARDS, renal failure, GI hemorrhage
metabolic--hypoCa, hyperCa, hyperTGA
pseudocyst formation (10-20%)
pancreatic necrosis (surgery if unstable)
infection (5%)
What should you do if abscess forms?
DRAIN and then antibiotics
What should you do if infected necrosis forms?
may need debridement and then antibiotics

Without debridement--there is nearly 100% mortality rate
How can you prevent pancreatitis?
lipid management
EtOH abstinence
low fat diet
elimination/management of any other causative factors
What are some causes of chronic pancreatitis?
continued abuse: EtOH, meds
hereditary: usually w/pepsinogen genes
ductal obstruction: trauma, pseudocyst, tumor, stones, pancreatic disvism
Tropical: unknown etiology, usually S. India and areas of the tropics
Systemic disease: CF, SLE, HyperTGA, Hypothyroidism
Idiopathic (many times likely related to an insufficienct history or pt not telling you everything
How do you treat chronic pancreatits?
same as with acute