Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CM GI Pancreatic Dz
Diseases of the Pancreas
| Question | Answer |
|---|---|
| function of bicarbonate | neutralize gastric acid |
| acute pancreatitis definition | Clinical syndrome defined by enzymatic damage to the pancreas resulting in discrete episodes of abdominal pain and elevation in serum amylase and lipase 3 times the upper limit of normal |
| key event in pancreatitis | inappropriate activation of trypsinogen to trypsin within the pancreas. Activated trypsin activates other proteases. Cascade of events – autodigestion locally & release of proinflammatory mediators that affect other organs systems distally |
| Acute interstitial pancreatitis | mild pancreatitis with pancreatic edema |
| Acute Necrotizing pancreatitis | severe pancreatitis with necrosis of parenchyma and blood vessels |
| Most common causes of acute pancreatitis | gallstones (35%, more often females), Alcohol (30% of cases, most often males), Obstruction, medications, infections, metabolic, toxins, vascular, abdominal trauma, post - ercp, inherited, idiopathic (20%) |
| Metabolic causes of pancreatitis | hypertriglyceridemia (usually >1000), hypercalcemia |
| Toxic causes of pancreatitis | alcohol, methylalcohol, scorpion sting |
| Vascular causes of pancreatitis | ischemia, vasculitis |
| Sx of pancreatitis | constant, epigastric pain radiating to the back. Usually associated with N/V, tachycardia secondary to hypovolemia, fever, systemic toxicity (sepsis), jaundice, decresaed breath sounds, distention, tenderness |
| Decreased breath sounds associated with pancreatitis is caused by | effusion |
| Ileus causes | decreased bowel sounds |
| Flank ecchymosis from retroperitoneal hemorrhage | Gray Turner's Syndrome. Leaking of blood from the pancreas. Acute necrotizing pancreatitis |
| Periumbilical ecchymosis | Cullen's sign. Leaking of blood from the pancreas. Acute necrotizing pancreatitis |
| Labs in pancreatitis | elevated amylase and lipase (must have clinical signs of pancreatitis) |
| Imaging in pancreatitis | Plain films, US, CT, MRCP (MRI that looks at biliary tree and pancreatic ducts), ERCP (endoscopically looks at biliary tree and pancreatic tree; intervention friendly) |
| Most commonly used pancreatic criteria | Ranson Criteria |
| Apache score >8 indicates | severe pancreatitis. Advantage of APACHE is that you don't have to wait 48 hours to calculate (ranson takes 2 days) and you perform this daily |
| Tx for pancreatitis | Pancreatic rest (NPO), IVF (dehydrated due to third-spacing), pain meds, if severe: monitor in ICU, prophylactic abx, jejunal feed after 3 days NPO |
| Local Complications of pancreatitis | Fluid collections, pancreatic necrosis (sterile or infected), pancreatic abscess |
| Non-local complications of pancreatitis | ARDS, sepsis, renal failure |
| Number one cause of chronic pancreatitis | Chronic Alcohol use accounts for 70% of cases |
| Causes of Chronic pancreatitis | Chronic alcohol use, chronic obstruction of pancreatic duct, tropical chronic pancreatitis (due to malnutrition), autoimmune (elevated IgG4), Genetics, Idiopathic |
| Clinical features of chronic pancreatitis | persistent/recurrent epigastric and LUQ pain, steatorrhea, Diabetes |
| Labs in Chronic pancreatitis | Amyslase (lipase usually not elevated b/c it is burned out), fecal fat, fecal elastase, secretin stimulation test |
| Radiology in Chronic Pancreatitis | Ab plan film, CT, MRCP, ERCP, EUS |
| Classic finding in chronic pancreatitis on imaging | pancreatic calcifications. |
| Chain of lakes is seen on which imaging studies in chronic pancreatitis? | MRCP, ERCP |
| Pancreatic adenocarcinoma epidemiology | mean age of onset 70's-80's, M:F = 1.3:1, most common location is head of pancreas |
| Biggest risk factor of Pancreatic adenocarcinoma | Tobacco Use. |
| Painless jaundice may be associated with | pancreatic adenocarcinom of the pancreas head. CBD is compressed. |
| Courvoiseir's sign | palpable GB due to head mass compressing CBD |
| Best imaging for pancreatic adenocarcinoma | CT. |
| If CT or MRI shows no mass, but you are still concerned, order a | endoscopic ultrasound |
| What is the risk associated with CT guided biopsy? | Seeding |
| Best option for tissue diagnosis in pancreatic adenocarcinoma | Endoscopic Ultrasound with FNA |
| Pancreatic adenocarcinoma may be resectable if | there is no vascular invasion, lymphatic involvement or mets |
| _____ of pancreatic adenocarcinoma patients present wtih mets at diagnosis | 50%. Mean survival is 3-6 months if metastatic |
| Which remains elevated longer? Lipase or Amylase? | Serum Lipase, for 3-5 days. May be helpful if patients seek medical attention several days following symptom onset |
| Steatorrhea | Due to pancreatic exocrine insufficiency resulting in fat malabsorption. Loose, greasy, malodorous stools. Fat soluble vitamin deficiency (A,D,E,K) |
Created by:
ltm12