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27 Cards in this Set
- Front
- Back
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what is the presumed cause of acute pancreatitis? what is considered the initial insult?
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leakage of activated pancreatic enzymes into the pancreas & surrounding tissues
initial insult: either obstructive or direct insult to the acinar cells (ie alcohol) |
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what are the sxs of acute pancreatitis a result of?
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extravasation of pancreatic enzymes into the pancreas & surrounding tissues along fascial planes, as well as lymphatic & vascular structures
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what are the two most common causes of acute/ chronic pancreatitis?
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alcohol & stones
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what are the 12 categories of causes of acute & chronic pancreatitis?
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obstructive
toxins drugs metabolic trauma iatrogenic infectious vascular idiopathic congenital AI misc: pregnancy, reye's syndrome, CF |
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what are the 6 drugs that common cause drug induced pancreatitis?
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asparaginase, azothiaprine, 6-mercaptopurine, didanosine, pentamidine, valproate
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what are the sns & sxs of acute pancreatitis? what is the most indicative sign?
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abdominal pain (epigastric) radiating to the back. positional. N/V, fever, tachycardia, diaphoresis, hypotension, pallor & cool clammy skin, pain on palpation of epigastrium, distention, & dec bowel sounds w/o rigidity or rebound.
--> GREY TURNER'S/CULLEN SIGN |
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what will be elevated in laboratory findings that is more specific for acute pancreatitis?
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lipase-- 3x normal limit w/n 2 hrs. Lipase takes longer to normalize.(4-5 days) in comparison to amylase.
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what diagnostic tool can you use for gallstones that you cannot use for acute pancreatitis?
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US bc the poancreas is poorly visulized d/t bowel air.
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what should be the first diagnostic tool used when suspicious of pancreatitis?
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CT: which will reveal enlarged pancreas & helps to distinguish edema, infection, pseudocyts & necrosis.
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what may be shown on plain films of the pancreas that is indicative of acute pancreatitis?
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colon "cut off sign"
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what is on the DDX for acute pancreatitis?
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PUD, DUD (perforated)
acute cholecystitis acute intestinal obstruction rupture aortic aneurysm acute mesenteric thrombosis acute bacterial peritonitis any acute abdomen. |
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what are the complications of acute pancreatitis?
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- massive volume depletion (frank renal failure)
- sterile or infected necrotizing pancreatitis - shock & multisystem organ failure - ARDS - erosion of major arteries (cullen's sign) - pancreatic ascites or pleural effusion - pancreatic abscess - pseudocysts - coagulopathy or DIC - splenic vein thrombosis - pancreatic fistula - chronic pancreatitis |
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what is the ranson's criteria for admission?
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admission eval: 3 or + predict severe course w/ ~75% sensation [ age>55, WBC >16,000, FBG >200, LDH >350, AST >250]
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what is the ranson's criteria for the first 48 hrs?
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3 or more predict worsening prognosis
- hct drop>10% - BUN rise >5 - PO2 <60 - seurm Ca <8 - fluid sequestration >6 |
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what is the #1 tx for a pt w/ acute pancreatitis? what is the #2 tx?
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NPO for several days!!
#2: TX of underlying cause (ie cholecystectomy) |
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how do you control the pain in a pt w/ acute pancreatitis? what are the SEs?
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w/ MS --> morphine
SE: constipation, pruritis, respiratory suppression, spasm of the sphincter of oddi. |
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what is an phlegmon?
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its an extrapancreatic fluid collection which is extravasated fluid & digestive juices around the pancrease & it usually resolves spontaneously
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what are pancreatic pseudocysts? how do you tx them?
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they are encapsulated pancreatic juice collection in or around the pancreas at least 4 weeks post onset in 25% of cases.
tx: <6 cm - if they don't go away= aspirate. >6cm or persistent cysts--> surgery (marsupialization) |
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what do pancreatic pseudocysts cause?
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pain, obstruction, infection, erosion, bleeding, rupture.
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what is a pancreatic abscess? tx?
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circumscribed collection of pus that contains little or no necrosis.
tx: endoscopic, radiologic, or surgical drainage & appropriate abx |
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what is a pancreatic fistula? tx?
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disruption of the duct, tx w/ endoscopic stenting, TPN (feed through vein), or surgical intervention
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how do you tx necrotizing pancreatitis?
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surgical intervention to debride necrotic tissue & establish adequate drainage & appropriate abx.
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what are the signs & sxs associated with chronic pancreatitis? what is the weight loss d/t?
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chronic or intermittent epigastric pain, steatorrhea, weight loss & pancreatic calcifications on xray
weight loss d/t malabsorption or anorexia sexondary to post prandial pain (food fear). |
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what is the #1 cause of chronic pancreatitis? how do the etiologies differ from acute?
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ETOH= #1 cause
all the same etiologies as acute except gallstones |
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what is the gold standard for diagnosing chronic pancreatitis?
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secretin stimulation test
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what are the complications of chronic pancreatitis? what is increased in chronic pancreatitis that is not increased in acute?
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1) chronic pain & opioid addiction is common
2) DM or jaundice 3) common bile duct stricture, steatorrhea, malnutrition & PUD 4) pancreatic pseudocysts & abscesses chronic = increased incidence of pancreatic cancer |
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how do you tx chronic pancreatitis?
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-low fat diet w/ complete abstinence of alcohol.
- pain control w/ narcotics - endoscopic or surgical stenting & drainage of obstruction is essential - pancreatic enzyme supplements (dec bloating & steatorrhea) - PPI's |
