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Details

GI-ICM
Pancreatic Disease
14
Medical
Graduate
02/23/2011

Additional Medical Flashcards

 


 

Cards

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

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