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30 Cards in this Set
- Front
- Back
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What cells of the pancreas are endocrine cells?
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Islets of langerhans:
alpha cells: glucagon beta cells: insulin delta cells: somatostatin |
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What cells of the pancreas are exocrine cells?
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centroacinar cells - HCO3-
basophilic cells |
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What are some rare acute pancreatitis etiologies?
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Obstructive
Metabolic Drugs Infection Trauma scorpion sting ischemia hereditary (trypsinogen mediated) cystic fibrosis |
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What are some rare obstructive reasons for acute pancreatitis?
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ampullary, pancreatic tumors and pancreatic divism
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What are some rare metabolic reasons for acute pancreatitis?
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HyperTGA and HyperCa++
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What are some rare Drug related-reasons for acute pancreatitis?
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furosemide, thiazide, sulfa, protease inhibitors, estrogen and asothiaprine
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What are some rare infection related reasons for acute pancreatitis?
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Coxsackie virus
mumps rubella EBV CMV HIV HAV HBV |
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What are some common reasons for acute pancreatitis?
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EtOH
Gallstones |
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What does the physical exam find with pancreatitis?
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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 |
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What will a pt with pancreatitis present with?
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fever, chills, nausea, vomiting, abdominal distention
mid-epigastric abdominal pain (radiates to the back--sometimes better sitting forward) |
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What is on your differential diagnosis when evaluating a pt with pancreatitis
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acute/chronic alcohol consumption
gallstone disease PUD or perforated ulcer early appendicits bowel obstruction, mesenteric ischemia medications gastritis Vs. GERD pregnancy pulmonary, renal or cardiovascular disorders |
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What labs do you need to order to diagnosis acute pancreatitis?
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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 |
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When doing an imaging study, which one would you chose to see if the pt has acute pancreatitis?
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abdominal CT--may appear normal (30%): looking for necrosis, pseudocyst, calcifications, gallstones?
Abdominal US: gallstones, common duct dilation ERCP (endoscopic retrograde cholangiopancreatography) |
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How is Mild pancreatitis defined?
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Ranson < 3
APACHE II < 8 CT index <7 |
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How is Severe pancreatitis defined?
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Ranson > 3
APACHE II > 8 CT index > 7 |
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What are the three ways to assess prognosis with pancreatitis?
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Ranson's criteria
APACHE II CT severity index (CT grade + necrosis score) |
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What is the scoring for Ranson's criteria at admission?
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1 - age > 55yo
2 - WBC > 16,000/ul 3 - blood glucose > 200mg/dl 4 - Serum LDH > 350 5 - SGOT (AST) > 250 |
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What is the scoring for Ranson's criteria at 48hrs?
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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 |
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How does the total scoring for Ranson's criteria match the mortality level?
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less than or equal to 2 = <5%
3-4 = 15-20% mortality 5-6 = 40% mortality greater than or equal to 7 = 99% mortality |
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What is included in the APACHE II equation?
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Age
Rectal temperature MAP heart rate PaO2 arterial pH serum K+, Na+, creatine hematocrit, WBC Glasgo Coma Scale score Chronic health status |
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With the CT severity index, how is CT grade scored?
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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) |
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What is the necrosis scoring in the CT severity index?
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<1/3 (2points)
1/3, but <1/2 (4points) 1/2 (6points) |
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What is the treatment for pancreatitis?
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rest the pancreas (NPO, NG) and give supportive care
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What is supportive care for a pancreatitis?
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fluids (may need up to 10L for severe pancreatitis with hemodynamic instability)
pain control anti-cholinergics antibiotics if evidence of necrosis insulin for severe hyperglycemia nutritional support when indicated ERCP if gallstone pancreatitis with biliary obstruction pancrealipase ICU if hemodynamically unstable |
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What are some complications of pancreatitis?
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shock, ARDS, renal failure, GI hemorrhage
metabolic--hypoCa, hyperCa, hyperTGA pseudocyst formation (10-20%) pancreatic necrosis (surgery if unstable) infection (5%) |
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What should you do if abscess forms?
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DRAIN and then antibiotics
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What should you do if infected necrosis forms?
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may need debridement and then antibiotics
Without debridement--there is nearly 100% mortality rate |
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How can you prevent pancreatitis?
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lipid management
EtOH abstinence low fat diet elimination/management of any other causative factors |
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What are some causes of chronic pancreatitis?
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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 |
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How do you treat chronic pancreatits?
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same as with acute
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