Session 3 Cm- Gi-8- Pancreatic Disease

Front 1

What is pancreatitis and what are the common causes of it

Back 1

inflammation of the pancrease can be caused by auto digestion of pancres (necrotizing) or more commonly (80%) of cases are due to obstructive gallstones or heavy ETOH use (interstitial)

Front 2

what are some unsual causes of pancreatitis

Back 2

hereditary (cystic fibrosis), Medications (thiazide, furosemide, tetracycline, azothiaprine, nitrofurantoin, oral contraceptives) Chemical Exposure, pregnancy, blunt trauma

Front 3

What is a complication of pancreatitis that is alarming because it can result in death in 10-15% of cases and can recurr if you don't treat precipitating factors

Back 3

Necrotizing Pancreatitis

Front 4

What is ranson's criteria for

Back 4

assesing how severe a pts acute pancreatitis is based on patient being either alcoholic or nonacoholic and certain criteria in the first 48hrs. If pt meets 3 criteria they need team management

Front 5

If patient meets 3 Ranson's criteria for acute pancreatitis what do they need?

Back 5

team management with intensivist, surgeon and gastroenteroligist, monitored in ICU they have a predicted mortality of 15%

Front 6

What is the predicted mortality if a patient meets 7-8 Ranson's criteria for acute pancreatitis

Back 6

100%

Front 7

what are the sx of acute pancreatitis

Back 7

diffuse severe upper abd pain, that radiates straight through the back unaffected by postion, may improve leaning forward. Pain escalates in intesity at peaks in 10-20min, N/V, dyspnea, narcotics don't help pain

Front 8

What are some signs of acute pancreatitis

Back 8

pallor, diaphoresis, tender upper abdomen, fever 101-103, abdominal distention, ileus, initial hypertension

Front 9

If patient has severe acute pancreatitis what signs are you possibly going to see

Back 9

guarding, tenderness w/ motion and percussion, Grey-Turner's sign (flank ecchymosis) Cullen's (periumbilical ecchymosis), increased heart rate, hypotension,

Front 10

What would you expect to see on following lab work up values if pt has acute pancreatitis, CBC, HCT, Serum Amylase, Urine Amylase, Serum Lipase, Serum Calcium, Serum glucose, LFT's, C-reactive protein

Back 10

CBC- looking ofr infection, HCT >47%, Serum amylase- sig if 3x normal, Urine amylase-confirms serum amylase, Serum lipase- sig if 3x normal, Serum glucose- hyperglycemia due to interference w/ insulin production,

Front 11

What procedure would you order that is diagnostic, prognostic and therapeutic value for acute pancreatitis

Back 11

CT/MRI

Front 12

How do you manage acute pancreatitis

Back 12

NPO (nothing by mouth), Give IV fluid replacement, bed rest, nasogastric suction, meperidine (demerol) analgesic drug of choice. If pt becomes pain free and bowel sounds are present start clear liquids, IF not start enteral/parenteral nutrition

Front 13

How do the following relate to pancreatitis: azotemia, pancreatic necrosis, internal pancreatic fistula, pseudoanuerysm, ARDS, pancreatic abcess, pseudocyst, diabets, steatorhea, intestinal obstruction

Back 13

All are possible complications of pancreatitis

Front 14

What is the prognosis of patient with acute pancreatitis

Back 14

80% will have mild episode that subsides in 7 days 3% will progres to severe and develop complication

Front 15

What is chronic pancreatitis

Back 15

recurrent persistent inflammation of the pancrease w/ pancreatic exocrine and endocrine insufficiency makred by strictures, calculi and dilation of pancreatic duct

Front 16

What are the irreversible pancreatic changes that characterize chronic pancreatitis

Back 16

Strictures, Calculi, dilation of pancreatic duct

Front 17

what is the etiology of chronic pancreatitis

Back 17

male>female, chronic alcoholism, obstruction, annular pancreas, herediatry pancreatitis, untreated hyperparathyroidism

Front 18

What pancreatitis is marked by infrequent attacks of abdominal pain, irregular narrowing of pancreatic duct, swelling of pancreatic parenchyma, high levels of immunoglobulin IgG4

Back 18

Sclerosing Pancreatitis

Front 19

What do you want to focus your history on in suspected pancreatitis

Back 19

EtOH use, lab tests, diagnositc imaging

Front 20

What labs do you want to test for chronic pancreatitis

Back 20

serum amylase and lipase, hyperglycemia, glycosuria, hyperbilirubinemia, increased alkaline phosphatase. 72hour fecal fat determination, bentiromide (confirms pancreatic insufficeincy) elevated serum IgG4

Front 21

What imaging studies do you want to order looking for acute pancreatitis

Back 21

plain abdominal x-ray(look for calcification), Ultrasound, endoscopic ultrasonography, CT scan, and ERCP

Front 22

If the chronic pancreatitis is autoimmune related how do you want to manage it

Back 22

glucocroticoids, aboid EtOH, frequent small vol low fat meals, avoid narcotics, enzyme supplements, octreotide, nerve block, treat complications

Front 23

What surgical options are available for treating chronic pancreatitis

Back 23

pancreatectomy, ERCP with sphincterectomy, stone extraction, psedocyst drainage, transduodenal sphincteroplasty, pancreaticojejunosotomy.

Front 24

What is the prognosis for patients with chronic pancreatitis

Back 24

long term survival is poor better if they have recurrent acute pancreatitis from cholelithiasis, hyperparathyroidism or stenosis of sphincter of oddi

Front 25

what type of cancer is pancreatic cancer and what is the survival rate

Back 25

pancreatic cancer is an adenocarcinoma of the epithelium of the pancreatic duct 5 year survival is 3%

Front 26

When are you most likely going to see a patient with pancreatic cancer

Back 26

male>female, in old age, AA>caucasian>asian/hispanics, 7% have family hx

Front 27

what are the risk factors for pancreatic cancer

Back 27

age, obesity, tobacco, chronic pancreatitis, industrial carcinogens, DDT, radiation, gasoline derivatives, hereditary, tropical pancreatitis, gastrectomy, diabetes, cytotoxic agents

Front 28

How do the following relate to pancreatic cancer multiple endocrine neoplasias, breast cancer BRCA2 mutation, peutz jegher's syndrome, neurofibramatosis, ataxia telangectasia, gardner's syndrome

Back 28

all hereditary syndromes that increase risk of developing pancreatic cancer

Front 29

what are the s/sx of pancreatic cancer

Back 29

persistent/recurrent epigastric pain, LUQ pain, pain referall to upper left lumbar region, anorexia, N/V, jaundice, GI bleed, excoriations on skin, constipation, flatulence, weight loss and cachexia, mild guarding, ileus, steatorrhea late in course

Front 30

When working up pancreatic cancer what labs would ou order

Back 30

serum lipase/amylase, LFT's, stool for occult blood, glucose, CBC, cancer antigen

Front 31

What imaging studies would you order for pancreatic cancer

Back 31

endoscopic ultrasound, CT of abdomen and pelivis, Chest x-ray, ERCP (90% sensitvie)

Front 32

What is the diagnostic procedure of choice for pancreatic cancer

Back 32

Percutaneous needle biopsy using ct guided or ultrasound guided. Sensitivity is 90% and specificty is 100%

Front 33

What are the tx options for pancreatic cancer

Back 33

surgery (either curative or palliative) Chemotherapy (streptozocin, mitromycin C, 5FU 19wk median survival), or combine chemo with radiation (mean survival is 11 months)