Surgery Cf Ch 31 Pancreatitis 1

Front 1

1. Treatment of acute pancreatitis?

Back 1

a. Resuscitative measures including administration of supplemental oxygen and IV fluids.

Front 2

2. Complications of Acute Pancreatitis?

Back 2

a. Local complications:
1. Haemorrhage
2. Necrosis
3. Fluid collection
4. Infection
b. Systemic complications:
1. Pulmonary, cardiac, and renal dysfunction

Front 3

3. What is the utility of amylase level for acute pancreatitis?

Back 3

a. It is helpful diagnosis but does not correlate with the severity of the disease.

Front 4

4. In acute pancreatitis patients fever, tachypnea, and hyperdynamic state caused by?

Back 4

a. Systemic inflammation related to acute pancreatitis.

Front 5

5. What should be monitored in a patient with severe acute pancreatitis in the ICU?

Back 5

a. Signs of distant organ dysfunction including:
1. Respiratory insufficiency (PaO2/FIO2)
2. Renal insufficiency (urine output in serum creatinine)
3. Cardiac dysfunction (blood pressure, Presser requirement)
4. Neurologic dysfunction (GCS).

Front 6

6. Presentation of severe pancreatitis?

Back 6

a. Patients experience severe catabolism leading to rapid loss of lean body mass, therefore nutritional support should be considered and initiated early to counterbalance this effect.
b. For most patients, intragastric or enteral nutritional support can be initiated as soon as initial resuscitation for shock is completed.

Front 7

7. Infected pancreatic necrosis?!?

Back 7

a. Infectious complication with necrotic pancreas and peripancreatic tissue.

Front 8

8. Cause of Infected pancreatic necrosis?

Back 8

a. Most frequently caused by secondary infection by bowel derived microorganisms within the 1st few weeks of onset

Front 9

9. Treatment of infected pancreatic necrosis?

Back 9

a. Antibiotic prophylaxis may be beneficial in preventing this complication
b. And operative the debridement is indicated in managing this process.

Front 10

10. Pancreatic abscess?

Back 10

a. Secondary infection of the pancreas and peripancreatic fluid collection.
b. This condition is usually encountered at 3 to 6 weeks after the onset of severe pancreatitis.

Front 11

11. How is pancreatic abscess recognized?

Back 11

a. By the accumulation of thick, purulent fluid and infected debris.

Front 12

12. Treatment of a pancreatic abscess?

Back 12

a. Surgical drainage is generally indicated in treating this condition.

Front 13

13. Infected pancreatic pseudocyst?

Back 13

a. Usually a late process that occurs several weeks or months after the onset of severe pancreatitis.
b. This process usually occurs ≥ 6 weeks following the onset of severe pancreatitis and can be adequately treated by percutaneous drainage.

Front 14

14. What are the 2 most common etiologies of acute pancreatitis?

Back 14

1. Gallstones
2. Alcohol consumption

Front 15

15. Why should acute pancreatitis be diagnosed early?

Back 15

a. Because it may alter the management of the disease.

Front 16

16. What is the diagnosis of acute pancreatitis based upon?

Back 16

a. The history and typical clinical presentation of:
1. Severe epigastric pain that radiates to the back
2. Nausea/vomiting
3. Fever.

Front 17

17. What confirms the diagnosis of acute pancreatitis?

Back 17

a. Serum amylase and lipase levels in patients with the symptoms above.
b. By themselves they are not diagnostic because they can be elevated another pathologic conditions.

Front 18

18. Pathologic presentation of mild pancreatitis (85% of cases)?

Back 18

a. Edema of the pancreas
b. Rarely proceeds to necrosis or infection

Front 19

19. Pathologic presentation of severe pancreatitis (15% of cases)?

Back 19

a. Necrosis of the pancreas may be complicated by infection in approximately 50% of cases.
b. ↑d microvascular permeability, leading to large volume losses of intravascular fluid into the tissues, thereby decreasing perfusion of the lungs, kidneys, and other organs.

Front 20

20. Most important elements in preventing multiple organ failure in severe acute pancreatitis?

Back 20

a. Fluid resuscitation and intensive monitoring.

Front 21

21. Note about Ranson’s criteria: Pts w/3 or more criteria have more severe disease and in increased risk of complications and death. However, w/current improvements in pt care, the high-mortality rates identified by the investigators are no longer applicable.

Back 21

21. Note about Ranson’s criteria: Pts w/3 or more criteria have more severe disease and in increased risk of complications and death. However, w/current improvements in pt care, the high-mortality rates identified by the investigators are no longer applicable.

Front 22

22. Significance of serum amylase and lipase levels?

Back 22

a. Although helpful in diagnosis, they do not correlate w/severity of pancreatitis.

Front 23

23. Significance of other prognostic systems such as APACHE II and C-reactive protein levels?

Back 23

a. Similar sensitivity and specificity to the Ranson criteria.

Front 24

24. What type of imaging should be performed when the diagnosis of pancreatitis is in question?

Back 24

a. Contrast-enhanced CT of the pancreas.

Front 25

25. With respect to contrast enhanced CT of the pancreas, what indicates severe disease and an increased risk of complications?

Back 25

a. 2 or more extrapancreatic fluid collections or necrosis (nonenhancement) of more than 50% of the pancreas.

Front 26

26. How often is necrotizing pancreatitis complicated by infection?

Back 26

a. ~50% of the time
b. Prophylactic antibiotics should be administered when necrosis is confirmed by CT scan.

Front 27

27. What 4 other complications can severe pancreatitis lead to?

Back 27

1. Hemorrhage
2. Splenic vein thrombosis
3. Pancreatic abscess
4. Pseudocyst formation

Front 28

28. Treatment of gallstone pancreatitis?

Back 28

a. Requires cholecystectomy once the pancreatitis has resolved.

Front 29

29. Initial treatment of acute pancreatitis?

Back 29

a. Nonoperative and focuses on:
i. Fluid resuscitation
ii. Pain management
iii. Maintenance ventilation
iv. Adequate oxygenation
v. Renal perfusion
b. Aggressive nutritional support improper electrolyte replacement are also important.
c. Approximately 85% of patients improved the support measures

Front 30

30. When is gastric decompression indicated for pancreatitis?

Back 30

a. In patients with severe nausea and vomiting

Front 31

31. What is one very effective antibiotic in penetrating the pancreas?

Back 31

a. Imipenem/cilastatin

Front 32

32. Percutaneous needle aspiration for pancreatitis?

Back 32

a. Percutaneous needle aspiration of fluid collections or necrotic areas found on CT imaging can be performed to identify the presence of infection and guide therapeutic decisions about the need for drainage.

Front 33

33. What is indicated for infected pancreatic necrosis or infected fluid in pancreatitis?

Back 33

a. Operative debridement and drainage.

Front 34

34. Treatment of patients with sterile necrosis pancreatitis?

Back 34

a. Generally improve with nonoperative therapy we antibiotics and intensive support.
b. However, surgical exploration may be indicated in patients showing clinical deterioration despite nonoperative therapy.

Front 35

35. Treatment of patients with gallstone pancreatitis (confirmed ultrasound)?

Back 35

a. May require ERCP if evidence of biliary obstruction persists.
b. This patient should undergo abdominal ultrasound on admission and daily serum liver function tests.
c. The total bilirubin level does not decrease, the patient should undergo ercp to clear the duct of stones and prevent biliary complications.
d. These patients usually undergo cholecystectomy before discharge to prevent recurrent attacks, which occur in up to one third of patients who do not undergo cholecystectomy.