| Question | Answer |
|---|
| Pain that radiates to the back can be a sign of | Gallstone, Pancreatitis, Myocardial Ischemia |
| Top two causes of Acute pancreatitis | Alcohol and Gallstones |
| Name two infectious causes of acute pancreatitis | Mumps and Ascariasis |
| An infant with meningitis who is treated with sulfonamides is at risk for what two GI disorders | Acute Pancreatitis and/or Kernicterus (displaces unconjugated bilirubin from albumin) |
| Define Ileus | Ileus is simply decreased motor activity of the GI tract due to non-mechanical causes |
| Name and describe the characteristic lab findings in a patient with Acute pancreatitis | 1) Serum Amylase will be elevated >3x normal beginning 2-12 hours after onset, peaking at 24-36 hours, and returning to normal around 2-4 days --> "Gold standard" for confirmation, but will be normal in up to 30% of patients with proven acute pancreatitis; 2) Urine Amylase is more sensitive than serum amylase and may be abnormal for up to 2 weeks; 3) Serum Lipase is more specific to acute pancreatitis than serum amylase --> will peak in 48-72 hours and will remain elevated for 4-7 days; 4) Hypocalcemia is a bad prgonostic indicator --> Occurs due to release lipase in pancreas leading to digestion of fats, which exposes negatively charged FA's that calcium binds to; 5) Hyperglycemia due to excess release of glucagon (NOTE: Insulin is also high) |
| Name the characteristic lab findings in a patient with acute pancreatitis | 1) Elevated serum and urine amylase >3x normal; 2) Elevated serum Lipase; 3) Hypocalcemia (may not be present but is a poor prognostic indicator); and 4) Hyperglycemia |
| What are some causes of increased serum amylase other than acute pancreatitis | 1) Intestinal Obstruction/infarction; 2) Ectopic pregnancy (high amylase in fallopian tubes); 3) Renal failure; 4) Other pancreatic diseases (carcinoma, pseudocyst); 5) Inflammation of partotid gland |
| Where else in the body can you find amylase other than the pancreas? | Fallopian tubes and the Parotid Glands |
| What is the most common complication of acute pancreatitis? | Pseudocyst (in up to 50% of cases) |
| Patient presents with nausea, vomiting, and abdominal pain that radiates to the back; Has increased serum amylase and lipase; Fever of 102 with a palpable mass in the abdomen, Diagnosis? | Acute pancreatitis complicated by a pancreatic abscess |
| Define Courvoisier's sign; What is it associated with? | Finding of a palpable gallbladder --> Associated with pancreatic cancer |
| Why is chronic pancreatitis somewhat of a misnomer? | Chronic pancreatitis is more like a scarring of the pancreas due to various causes rather than a chronic version of acute pancreatitis --> This is supported by the fact that Amylase and Lipase are normal, but pancreatic enzymes are decreased |
| What is Cullen's sign? What is it associated with? | Periumbilical ecchymosis (bruise) --> Associated with acute pancreatitis (very rare finding); Pancreatitis can cause hemolysis  |
| What is Grey Turner's sign? What is it associated with? | Flank ecchymosis (bruise) --> Associated with acute pancreatitis (very rare finding); Pancreatitis can cause hemolysis  |
| T/F The magnitude of pancreatitis is associated with the magnitude of amylase elevation | False, there is not a correlation between extent of increased amylase and magnitude of pancreatitis |
| Describe the mechanism behind volume loss in a patient with acute pancreatitis | With pancreatic cell damage/necrosis, cytokines are released into the circulation and can cause multi-system failure, including increased vascular permeability --> This leads to volume loss that can cause hypotension and perhaps even shock --> Can also see DIC, ARDS and SIRS in response to cytokines --> NOTE: 75-80% of patients do not have global symptoms and the acute pancreatitis resolves |
| What findings on an x-ray can be found in a patient with acute pancreatitis? | 1. Pleural Effusion or Atelectasis; 2. ARDS; 3. Congestive Heart Failure (All caused by pro-inflammatory cytokine release) |
| What is the colon cut-off sign? What is it associated with? | Associated with acute pancreatitis   |
| What is the most important imaging study in a patient with acute pancreatitis? | CT with radio contrast (unless kidney failure) |
| How do you treat acute pancreatitis? | 1) FLUIDS, FLUIDS, FLUIDS!; 2) No eating (NPO); 3) Meperidine for pain control; 4) Antibiotics to prevent infectious complication |
| How do you handle a patient's food/nutrient demand during acute pancreatitis? | 1. No oral feeding for the first 3-5 days, but can begin when pain resolves and amylase close to normal 2. First few days, usually enteral feeding (tube all the way down to intestine, past pancreas) or parenteral feeding (IV) |
| What are the signs/symptoms of chronic pancreatitis? | 1) Abdominal pain; 2) Fatty stools; 3) Scarring/Calcification of pancreas; 4) Weight loss; 5) Normal amylase/lipase; 6) Diabetes (glucose intolerance) |
| Define Pancreas divisum; What is it associated with? | a congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts --> Can cause acute or chronic pancreatitis |
| Annular Pancreas: Associated with acute or chronic pancreatitis? | Acute |
| Treatment for Chronic Pancreatitis | 1) Give pancreatic enzymes; 2) Control Diabetes; 3) Counsel on alcohol; 4) Low fat diet; 5) |
| Complication associated with chronic pancreatitis | Thrombosis of splenic vein --> Can lead to gastric varices and bleeding --> Will present with upper GI bleed |
| Association of painless jaundice | Pancreatic cancer |
| Elevated CEA is usually associated with what two diseases? | Colon and Pancreatic cancer (CEA stands for Carcinoembryonic Antigen) |
| Elevated CA19-9 and CEA is associated with | Pancreatic cancer |
| Finding of a double duct sign on ERCP is associated with | Pancreatic cancer  |
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