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27 Cards in this Set

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what is the presumed cause of acute pancreatitis? what is considered the initial insult?
leakage of activated pancreatic enzymes into the pancreas & surrounding tissues

initial insult: either obstructive or direct insult to the acinar cells (ie alcohol)
what are the sxs of acute pancreatitis a result of?
extravasation of pancreatic enzymes into the pancreas & surrounding tissues along fascial planes, as well as lymphatic & vascular structures
what are the two most common causes of acute/ chronic pancreatitis?
alcohol & stones
what are the 12 categories of causes of acute & chronic pancreatitis?
obstructive
toxins
drugs
metabolic
trauma
iatrogenic
infectious
vascular
idiopathic
congenital
AI
misc: pregnancy, reye's syndrome, CF
what are the 6 drugs that common cause drug induced pancreatitis?
asparaginase, azothiaprine, 6-mercaptopurine, didanosine, pentamidine, valproate
what are the sns & sxs of acute pancreatitis? what is the most indicative sign?
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
what will be elevated in laboratory findings that is more specific for acute pancreatitis?
lipase-- 3x normal limit w/n 2 hrs. Lipase takes longer to normalize.(4-5 days) in comparison to amylase.
what diagnostic tool can you use for gallstones that you cannot use for acute pancreatitis?
US bc the poancreas is poorly visulized d/t bowel air.
what should be the first diagnostic tool used when suspicious of pancreatitis?
CT: which will reveal enlarged pancreas & helps to distinguish edema, infection, pseudocyts & necrosis.
what may be shown on plain films of the pancreas that is indicative of acute pancreatitis?
colon "cut off sign"
what is on the DDX for acute pancreatitis?
PUD, DUD (perforated)
acute cholecystitis
acute intestinal obstruction
rupture aortic aneurysm
acute mesenteric thrombosis
acute bacterial peritonitis
any acute abdomen.
what are the complications of acute pancreatitis?
- 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
what is the ranson's criteria for admission?
admission eval: 3 or + predict severe course w/ ~75% sensation [ age>55, WBC >16,000, FBG >200, LDH >350, AST >250]
what is the ranson's criteria for the first 48 hrs?
3 or more predict worsening prognosis
- hct drop>10%
- BUN rise >5
- PO2 <60
- seurm Ca <8
- fluid sequestration >6
what is the #1 tx for a pt w/ acute pancreatitis? what is the #2 tx?
NPO for several days!!
#2: TX of underlying cause (ie cholecystectomy)
how do you control the pain in a pt w/ acute pancreatitis? what are the SEs?
w/ MS --> morphine

SE: constipation, pruritis, respiratory suppression, spasm of the sphincter of oddi.
what is an phlegmon?
its an extrapancreatic fluid collection which is extravasated fluid & digestive juices around the pancrease & it usually resolves spontaneously
what are pancreatic pseudocysts? how do you tx them?
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)
what do pancreatic pseudocysts cause?
pain, obstruction, infection, erosion, bleeding, rupture.
what is a pancreatic abscess? tx?
circumscribed collection of pus that contains little or no necrosis.

tx: endoscopic, radiologic, or surgical drainage & appropriate abx
what is a pancreatic fistula? tx?
disruption of the duct, tx w/ endoscopic stenting, TPN (feed through vein), or surgical intervention
how do you tx necrotizing pancreatitis?
surgical intervention to debride necrotic tissue & establish adequate drainage & appropriate abx.
what are the signs & sxs associated with chronic pancreatitis? what is the weight loss d/t?
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).
what is the #1 cause of chronic pancreatitis? how do the etiologies differ from acute?
ETOH= #1 cause

all the same etiologies as acute except gallstones
what is the gold standard for diagnosing chronic pancreatitis?
secretin stimulation test
what are the complications of chronic pancreatitis? what is increased in chronic pancreatitis that is not increased in acute?
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
how do you tx chronic pancreatitis?
-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