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22 Cards in this Set

  • Front
  • Back
what two pancreatic enzymes are secreted by the pancreas that are actively measurable for assessment of the pancreas
amylase and lipase
osteopathic findings for a person with a pancreas problem?
T5-T9 and T9-12

normally on the left side (majority of pancreas is here)
Chapman's points for pancreas?
Anterior point lies between the costal cartilages of the 7th and 8th ribs
Mr. Jones is a 45 y/o male with a history of severe, progressively increasing non-colicky pain that is associated with anorexia, nausea and vomiting. He notes that the pain radiates though to the back. He takes medication only occasional for indigestion. He denies previous medical or surgical illness. His history is positive for episodic alcohol and admitted to having 6 beers in the last 3 days. Vitals are Temp. 99.5 F, pulse 130, resp. rate 28, and B/P 95/50
--PROGRESSIVE AND NON-COLICKY

-RADIATES TO BACK

acute necrotizing pancreatitis
what are the two types of acute pancreatitis?
Acute interstitial pancreatitis
Acute hemorrhagic (necrotizing) pancreatitis
mechanism of acute pancreatitis?
Intracellular activation of digestive enzyme and autodigestion

Pancreatic zymogens converted to active enzymes

Inflammatory mediators are generated:
Tumor necrosis factor alpha
Platelet-activating factor
Chemokines (ie IL-6)

Recruitment of inflammatory cells

Leukocyte activation causes distant organ injury=> multisystem organ failure

SIRS and pancreatic infection 2 major causes of death
Steady and rapid in onset, constant , radiates to the midback, lasts hours to days, and not relieved with vomiting
Biliary colic may progress to acute pancreatitis
History of binge drinking 1-3 days prior

these are the symptoms of...?
acute pancreatitis
what are the 2 biggest causes of acute pancreatitis?
Gallstone

Alcohol induced
What medications can lead to acute pancreatitis?
AIDS medication

Diuretics

ACE inhibitors

(so look for pts with diabetes or heart problems)
which stays elevated longer, lipase or amylase in acute pancreatitis? Which is the single test of choice for pancreatitis?
Lipase stays elevated longer and is the test of choice
What imaging modality is key for evaluating the extent and severity of pancreatitis?

***
CT
you must have 2 of 3 features of acute pancreatitis...what are the 3?

****
Characteristic abdominal pain

Serum amylase and/or lipase > 3 times the upper limit of normal

Characteristic findings of acute pancreatitis on CT scan
Risk Factors of Severity at Admission?
age>55
Obesity (BMI>30)
organ failure
pleural effusion
comorbid disease
prior episodes
interval between onset of symptoms and hospitalizatoin
best predictors of necrotizing pancreatitis?

-may be worth knowing..
Serum hematocrit (q 12 Hr for first 24 Hr)

> 44 at admission and failure to decrease in the first 24 Hr
Encephalopathy is an important possible organ failure...

(just read)
of pancreatitis
what is soponofication of the pancreas?
digestion of fat and calcium deposits are left

looks soaplike
What can help stop necrotizing pancreatitis? how?

**TEST
Enteral feedings

maintains mucosa of GI tract so there is not a translation of bacteria into the inflamed areas

want to do it with a NJ (jejunal) tube
just read:

sepsis and necrotizing pancreatitis can look really similar
so it is kind of up in the air if you should use prophylactic antibiotics
drugs that are commonly associated with pancreatitis

*****
ACE and Diuretics
pathophysiology resulting in hemorrhagic pancreatitis

***
activation of zymogens

zymogens cause necrosis and hemorrhage and vascular occlusion
The student will be able to list the types of severity scales used in the management of pancreatitis (list what scores are severe for Ranson, APACHE-II, and CT severity index)

Objective
Ranson signs > 3
APACHE-II score > 8
CT severity Index > 7
the general approach to the treatment of acute pancreatitis.

***
fluids, enteral feedings, supportive,

soft diet early on