Term
What are the most common causes of pancreatitis?
What is the pathogenesis?
What is a predisposing factor? |
|
Definition
Gallstones
Alcohol
Pathogenesis:
1)Bile Reflux/Alcohol/Hypercalcemia cause enzymes to pass pancreatic duct into interstitium
2)Patients deficient in Pancreatic Secretory Trypsin Inhibitor are more prone
3) Enzymes activate cytokine cascade
|
|
|
Term
Characteristic pain of Acute Pancreatitis
Other Physical exam findings
What enzymes might be elevated?
What position makes the pain the worst? |
|
Definition
Epigastric or Paraumbilical Pain radiating to the back
Pain: Better sitting up, worse when lying
Vomiting(w/o relief and Nausea)
PE:
Fever
Cullen's Sign: Periumbilical ecchymosis
Grey-Turner Sign: Ecchymosis in flanks
Enzymes: Amylase, Lipase, ALT, AST, ALP, GGTP |
|
|
Term
What are the imaging techniques used to evaluate possible pancreatitis?
When is each used? |
|
Definition
CT Scan w/ Contrast: ID necrosis(best test)
Ultrasound: Biliary Evaluation
X-rays: Rule out other causes
ERCP: Biliary Pancreatitis(stone extraction) |
|
|
Term
What are the components of Ranson criteria?
Which is the most important in tracing the course of pancreatitis |
|
Definition
O hours GA LAW
Glucose
Age
LDH
AST
WBC
48 Hours C. HOBBS
Ca
HCT
pO2
BUN: Most important for course
Base Deficit
Sequestration-Fluid Deficit |
|
|
Term
| What are the managements the mild and severe acute of Pancreatitis |
|
Definition
Acute
NPO
Fluids/Electrolytes
Analgesic
ERCP
Severe
ICU
O2
NPO
Analgesic
Enteral nutrition if possible
CT w/ contrast
ERCP
Anti-biotics |
|
|
Term
| What are the local and severe complications of pancreatitis |
|
Definition
Local
Pseudocyst
Hemorrhage
Abcess
Splenic and Portal vein Thrombosis
Severe
Renal Failure
ARDS
Shock/DIC
GI Bleed
Fistulas |
|
|
Term
| How is the pancreatic pseudocyst treated |
|
Definition
<5 cm: local treatment
>5 cm:
Drained in to stomach or Duodenum if touching
If Isolated, Invasive surgery |
|
|
Term
| How are abcesses from pancreatitis treated |
|
Definition
Drainage and multiple Anti-biotics
Otherwise surgery |
|
|
Term
| What are indications for surgery in acute pancreatitis |
|
Definition
Refractory Abcess
Necrosis
Biliary Pancreatitis
Pseudocyst |
|
|
Term
What are some causes of chronic Pancreatitis?
What is the pathogenesis?
What is the common presentation?
What type of stones are found? |
|
Definition
Alcohol 70%
Hyperparathyroid, CF, Hereditary
Pathogenesis:
Protein deposit in ducts causing calcium carbonate stones*
Presentation:
Acute Pancreatic signs
Weight Loss
Steatorrhea
DM
Upper GI Bleed |
|
|
Term
What are the imaging modalities use to evaluate chronic Pancreatitis?
Which is most sensitive? |
|
Definition
X-Ray
Ultrasound
CT Scan
ERCP-Most sensitive |
|
|
Term
How is the secretory function of the pancreas evaluated?
How is Chronic Pancreatitis commonly treated? |
|
Definition
Secretory function: Secretin Test
Treatment
No alcohol
PPIs
Pancreatic Enzymes
Octreotide
|
|
|
Term
What are the signs of Pancreatic Carcinoma?
Are there any markers?
How is it usually diagnosed?
How is it commonly treated |
|
Definition
Ab pain radiation to back
Obstructive Jaundice
Diabetes Mellitis
Depression
Trousseau's Sign: Migratory Thrombophlebitis
Courvoiser's Sign: GB dilation from common bile duct blockage
Marker: CA19-9 Not specific or Sensitive
Dx: Imaging
Ultrasound
Ab CT
ERCP for tx
Tx
Whipple:Pancreaticoduodenectomy if only head
Palladitive: gastrojejunostomy or cholecystojejunostomy |
|
|
Term
Presentation of:
Acute Pancreatitis
Chronic Pancreatitis
Pancreatic Adenocarcinoma |
|
Definition
Acute
Epigastic Pain radiating to the back
Nausea and Vomiting
Cullen's Sign: Periumbilical Eccymosis
Grey-Turner's Sign: Eccymosis in the flank
Chronic
Acute Pancreatitis Pain
Obstructive Jaundice
Steatorrhea
Weight Loss
Diabetes Mellitis
GI bleed
Pancreatic Adenocarcinoma
Acute Pancreatitis Pain
Painless Jaundice and Pruritis
Depression
Diabetes Mellitis
Trousseau's Sign-Migratory Thrombophlebitis
Courvoisier Sign- Dialated gallbladder |
|
|
