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Session 3 CM- GI-8

CM- GI-8- Pancreatitis

What is pancreatitis and what are the common causes of it inflammation of the pancrease can be caused by auto digestion of pancres (necrotizing) or more commonly (80%) of cases are due to obstructive gallstones or heavy ETOH use (interstitial)
what are some unsual causes of pancreatitis hereditary (cystic fibrosis), Medications (thiazide, furosemide, tetracycline, azothiaprine, nitrofurantoin, oral contraceptives) Chemical Exposure, pregnancy, blunt trauma
What is a complication of pancreatitis that is alarming because it can result in death in 10-15% of cases and can recurr if you don't treat precipitating factors Necrotizing Pancreatitis
What is ranson's criteria for assesing how severe a pts acute pancreatitis is based on patient being either alcoholic or nonacoholic and certain criteria in the first 48hrs. If pt meets 3 criteria they need team management
If patient meets 3 Ranson's criteria for acute pancreatitis what do they need? team management with intensivist, surgeon and gastroenteroligist, monitored in ICU they have a predicted mortality of 15%
What is the predicted mortality if a patient meets 7-8 Ranson's criteria for acute pancreatitis 100%
what are the sx of acute pancreatitis diffuse severe upper abd pain, that radiates straight through the back unaffected by postion, may improve leaning forward. Pain escalates in intesity at peaks in 10-20min, N/V, dyspnea, narcotics don't help pain
What are some signs of acute pancreatitis pallor, diaphoresis, tender upper abdomen, fever 101-103, abdominal distention, ileus, initial hypertension
If patient has severe acute pancreatitis what signs are you possibly going to see guarding, tenderness w/ motion and percussion, Grey-Turner's sign (flank ecchymosis) Cullen's (periumbilical ecchymosis), increased heart rate, hypotension,
What would you expect to see on following lab work up values if pt has acute pancreatitis, CBC, HCT, Serum Amylase, Urine Amylase, Serum Lipase, Serum Calcium, Serum glucose, LFT's, C-reactive protein CBC- looking ofr infection, HCT >47%, Serum amylase- sig if 3x normal, Urine amylase-confirms serum amylase, Serum lipase- sig if 3x normal, Serum glucose- hyperglycemia due to interference w/ insulin production,
What procedure would you order that is diagnostic, prognostic and therapeutic value for acute pancreatitis CT/MRI
How do you manage acute pancreatitis NPO (nothing by mouth), Give IV fluid replacement, bed rest, nasogastric suction, meperidine (demerol) analgesic drug of choice. If pt becomes pain free and bowel sounds are present start clear liquids, IF not start enteral/parenteral nutrition
How do the following relate to pancreatitis: azotemia, pancreatic necrosis, internal pancreatic fistula, pseudoanuerysm, ARDS, pancreatic abcess, pseudocyst, diabets, steatorhea, intestinal obstruction All are possible complications of pancreatitis
What is the prognosis of patient with acute pancreatitis 80% will have mild episode that subsides in 7 days 3% will progres to severe and develop complication
What is chronic pancreatitis recurrent persistent inflammation of the pancrease w/ pancreatic exocrine and endocrine insufficiency makred by strictures, calculi and dilation of pancreatic duct
What are the irreversible pancreatic changes that characterize chronic pancreatitis Strictures, Calculi, dilation of pancreatic duct
what is the etiology of chronic pancreatitis male>female, chronic alcoholism, obstruction, annular pancreas, herediatry pancreatitis, untreated hyperparathyroidism
What pancreatitis is marked by infrequent attacks of abdominal pain, irregular narrowing of pancreatic duct, swelling of pancreatic parenchyma, high levels of immunoglobulin IgG4 Sclerosing Pancreatitis
What do you want to focus your history on in suspected pancreatitis EtOH use, lab tests, diagnositc imaging
What labs do you want to test for chronic pancreatitis serum amylase and lipase, hyperglycemia, glycosuria, hyperbilirubinemia, increased alkaline phosphatase. 72hour fecal fat determination, bentiromide (confirms pancreatic insufficeincy) elevated serum IgG4
What imaging studies do you want to order looking for acute pancreatitis plain abdominal x-ray(look for calcification), Ultrasound, endoscopic ultrasonography, CT scan, and ERCP
If the chronic pancreatitis is autoimmune related how do you want to manage it glucocroticoids, aboid EtOH, frequent small vol low fat meals, avoid narcotics, enzyme supplements, octreotide, nerve block, treat complications
What surgical options are available for treating chronic pancreatitis pancreatectomy, ERCP with sphincterectomy, stone extraction, psedocyst drainage, transduodenal sphincteroplasty, pancreaticojejunosotomy.
What is the prognosis for patients with chronic pancreatitis long term survival is poor better if they have recurrent acute pancreatitis from cholelithiasis, hyperparathyroidism or stenosis of sphincter of oddi
what type of cancer is pancreatic cancer and what is the survival rate pancreatic cancer is an adenocarcinoma of the epithelium of the pancreatic duct 5 year survival is 3%
When are you most likely going to see a patient with pancreatic cancer male>female, in old age, AA>caucasian>asian/hispanics, 7% have family hx
what are the risk factors for pancreatic cancer age, obesity, tobacco, chronic pancreatitis, industrial carcinogens, DDT, radiation, gasoline derivatives, hereditary, tropical pancreatitis, gastrectomy, diabetes, cytotoxic agents
How do the following relate to pancreatic cancer multiple endocrine neoplasias, breast cancer BRCA2 mutation, peutz jegher's syndrome, neurofibramatosis, ataxia telangectasia, gardner's syndrome all hereditary syndromes that increase risk of developing pancreatic cancer
what are the s/sx of pancreatic cancer persistent/recurrent epigastric pain, LUQ pain, pain referall to upper left lumbar region, anorexia, N/V, jaundice, GI bleed, excoriations on skin, constipation, flatulence, weight loss and cachexia, mild guarding, ileus, steatorrhea late in course
When working up pancreatic cancer what labs would ou order serum lipase/amylase, LFT's, stool for occult blood, glucose, CBC, cancer antigen
What imaging studies would you order for pancreatic cancer endoscopic ultrasound, CT of abdomen and pelivis, Chest x-ray, ERCP (90% sensitvie)
What is the diagnostic procedure of choice for pancreatic cancer Percutaneous needle biopsy using ct guided or ultrasound guided. Sensitivity is 90% and specificty is 100%
What are the tx options for pancreatic cancer surgery (either curative or palliative) Chemotherapy (streptozocin, mitromycin C, 5FU 19wk median survival), or combine chemo with radiation (mean survival is 11 months)
Created by: smaxsmith