Acute Pancreatitis Management Quiz
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What imaging technique is used to determine the presence of common bile duct stones?

  • X-ray
  • CT scan
  • Ultrasound
  • Magnetic resonance cholangiopancreatography (MRCP) (correct)

    • EUS can be performed to determine biliary obstruction without cholangitis.

    True

    What is the purpose of performing ERCP?

    To remove bile duct stones.

    When in doubt about biliary obstruction, __________ could be performed to clarify the diagnosis.

    <p>MRCP or EUS</p> Signup and view all the answers

    Match the diagnostic method with its related purpose:

    <p>MRCP = Visualizing biliary system EUS = Assessing biliary obstruction ERCP = Removing bile duct stones CT scan = General abdomen imaging</p> Signup and view all the answers

    What is the main reason for the panel's disagreement about the superiority of RL over NS in the AGA guidelines?

    <p>Low quality of evidence for major clinical outcomes</p> Signup and view all the answers

    Colloids are recommended for their beneficial effects on survival rates.

    <p>False</p> Signup and view all the answers

    What major adverse events were reported more frequently in the HES group compared to the NS group during the CHEST trial?

    <p>Acute kidney injury, pruritis, and skin rash</p> Signup and view all the answers

    The initial management of AP widely recommends early aggressive __________.

    <p>hydration</p> Signup and view all the answers

    Which type of colloid is NOT recommended due to potential adverse effects?

    <p>All of the above</p> Signup and view all the answers

    Match the following studies with their findings regarding fluid resuscitation in AP:

    <p>RCT in China 1 = Worse clinical outcomes with aggressive fluid therapy RCT in China 2 = Worse clinical outcomes with aggressive fluid therapy Wu et al. = No differences between GDT and standard fluid therapy Buxbaum et al. = Study results not specified</p> Signup and view all the answers

    Intravenous albumin infusion was found to improve the clinical prognosis of patients with AP.

    <p>False</p> Signup and view all the answers

    What was the main finding of the PROCAP trial regarding procalcitonin-guided antibiotic use?

    <p>It significantly decreased the probability of being prescribed an antibiotic without increasing the risk of infection.</p> Signup and view all the answers

    What are the types of colloids mentioned that are not recommended?

    <p>Semi-synthetic colloids, hydroxyethyl starch (HES), gelatin, dextran solutions, and natural colloid (human albumin solution)</p> Signup and view all the answers

    Elevated C-reactive protein levels definitively indicate infection in acute pancreatitis patients.

    <p>False</p> Signup and view all the answers

    What is the most common cause of acute pancreatitis?

    <p>Gallstones</p> Signup and view all the answers

    The PROCAM trial specifically investigated the use of a ______ algorithm to guide antibiotic use in patients with AP.

    <p>procalcitonin</p> Signup and view all the answers

    What is one of the systemic symptoms that can present in acute pancreatitis patients?

    <p>Fever</p> Signup and view all the answers

    Match the following conditions or terms with their descriptions:

    <p>Procalcitonin = A biomarker used to guide antibiotic treatment Acute pancreatitis = Clinical condition often caused by gallstones ERCP = Procedure for removing bile duct obstructions C-reactive protein = A marker of inflammation in the body</p> Signup and view all the answers

    Gallstones can lead to acute pancreatitis by causing ______ in the common bile duct.

    <p>impaction</p> Signup and view all the answers

    The use of a procalcitonin algorithm increases the likelihood of antibiotic overuse in patients with acute pancreatitis.

    <p>False</p> Signup and view all the answers

    What was found to not reduce the risk of pancreatic complications in patients without cholangitis?

    <p>Performing early ERCP</p> Signup and view all the answers

    Early ERCP is effective in reducing organ failure among patients with severe acute biliary pancreatitis.

    <p>False</p> Signup and view all the answers

    What condition was not present in patients undergoing early ERCP according to the findings?

    <p>cholangitis</p> Signup and view all the answers

    The necessity of early ERCP was analyzed in a review of _____ RCTs.

    <p>eight</p> Signup and view all the answers

    Match the following conditions with their associated outcomes:

    <p>Early ERCP = No reduction in pancreatic complications Cholangitis = Presence affects treatment approach Severe acute biliary pancreatitis = High risk for organ failure Systematic review = Evaluates multiple studies</p> Signup and view all the answers

    What is a potential complication of gallstone pancreatitis?

    <p>Cholangitis</p> Signup and view all the answers

    Urgent ERCP is recommended within 48 hours for all patients with gallstone pancreatitis.

    <p>False</p> Signup and view all the answers

    What does ERCP stand for?

    <p>Endoscopic Retrograde Cholangiopancreatography</p> Signup and view all the answers

    Patients with gallstone pancreatitis may develop __________, which is a serious infection of the bile duct.

    <p>cholangitis</p> Signup and view all the answers

    When is the optimal timing for therapeutic ERCP in patients without cholangitis?

    <p>24-48 hours after diagnosis</p> Signup and view all the answers

    Cholangitis is a life-threatening complication that can arise from untreated gallstone pancreatitis.

    <p>True</p> Signup and view all the answers

    What is the purpose of performing urgent ERCP in patients with gallstone pancreatitis?

    <p>To provide rapid biliary decompression and alleviate the severity of pancreatitis.</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Gallstone pancreatitis = Inflammation of the pancreas due to gallstones ERCP = A procedure for diagnosing and treating biliary and pancreatic duct issues Cholangitis = Infection of the bile duct Biliary decompression = Relief of pressure in the bile duct system</p> Signup and view all the answers

    What is the trend in the management of biliary obstruction as indicated in the content?

    <p>Shift towards a more conservative strategy</p> Signup and view all the answers

    There is a growing inclination towards a more aggressive treatment approach for biliary obstruction.

    <p>False</p> Signup and view all the answers

    What indication reflects a need for ERCP in cases of persistent biliary obstruction?

    <p>Presence of cholangitis</p> Signup and view all the answers

    The shift towards a more conservative strategy reflects a broader trend in the practice of ________ care.

    <p>personalized</p> Signup and view all the answers

    Match the condition with its related strategy:

    <p>Persistent cholangitis = ERCP intervention Biliary obstruction = Conservative management Growing indication = Personalized care ERCP = Diagnosis and treatment</p> Signup and view all the answers

    Which of the following statements is true based on the content?

    <p>There is emphasis on less aggressive treatment in certain cases.</p> Signup and view all the answers

    The presence of cholangitis is an indication for conservative management.

    <p>False</p> Signup and view all the answers

    What medical procedure is being reserved for cases of persistent biliary obstruction?

    <p>ERCP</p> Signup and view all the answers

    Study Notes

    Acute Pancreatitis Treatment Strategies

    • Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations globally, with incidence increasing
    • Initial management within the first 72 hours is crucial for impacting clinical outcomes
    • Key initial management components include: assessing severity, fluid resuscitation, pain control, nutrition support and antibiotic use (ERCP in gallstones)
    • Updated fluid resuscitation strategies emphasize non-aggressive, goal-directed approaches with lactated Ringer's solution instead of normal saline
    • Early enteral feeding is beneficial
    • Prophylactic antibiotic use is often limited, with procalcitonin-based algorithms used for appropriate assessment of inflammation vs infection
    • Urgent ERCP is recommended for gallstone pancreatitis and cholangitis but not in the absence of cholangitis

    Initial Management (First 72 hours)

    • AP severity is crucial for predicting prognosis and guiding management (Revised Atlanta Classification)
    • Persistent organ failure for >48 hours indicates severe AP (mortality rate up to 43%)
    • Many prognostic models exist but no single model consistently superior in significant comparisons during early disease course (accuracy around 80%)
    • Systemic Inflammatory Response Syndrome (SIRS) and Bedside Index of Severity of Acute Pancreatitis (BISAP) score are relevant validated tools

    Fluid Resuscitation

    • Aggressive hydration is traditionally used. However, overtreatment is detrimental in severe AP
    • Goal-directed therapy (GDT) aims to address specific physiological targets, such as heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), urine output (UO), central venous oxygen saturation (ScvO2), blood urea nitrogen (BUN), hematocrit, and lactate levels
    • GDT was not found to significantly improve outcomes but it provides a structured, physiological-targeted approach, especially in severe cases. However, careful monitoring and frequent assessment, at 2-3 hour intervals is paramount
    • Appropriate fluid type and volume depend on patient parameters; in mild cases, oral feeding can be initiated 12 hours after symptom onset

    Fluid Type

    • Isotonic crystalloid solutions (normal saline, lactated Ringer's, Plasma-Lyte, Hartmann's) are generally favored in AP
    • Balanced crystalloids (lactated Ringer's) are increasingly preferred over normal saline due to potential adverse effects (hyperchloremic non-anion gap acidosis, acute kidney injury)
    • Results from recent RCTs indicate the potential advantage of balanced crystalloids.

    Pain Control

    • Opioids are effective but caution is recommended due to potential complications (respiratory depression, constipation, and dependence)
    • NSAIDs and acetaminophen are alternative options and can be equally effective in moderate cases, with caution in patients with renal impairment, gastric ulcers, or bleeding risks

    Nutritional Support

    • Early enteral feeding (within 24-48 hours) is now preferred over parenteral nutrition in most cases to reduce hospital stays, complications, and improve patient outcomes.
    • For patients intolerant of oral feeding within 72h, an enteral tube may be necessary

    Prophylactic Antibiotic Use

    • Procalcitonin-guided antibiotic use is preferred

    Cholecystectomy

    • Prophylactic cholecystectomy is recommended during initial hospital admission for AP cases involving gallstones.
    • Same-admission cholecystectomy ( within 7 days ) is often more effective than delayed cholecystectomy, especially in case of mild AP

    Lipid-Lowering Medications

    • These are crucial in hypertriglyceridemia-induced acute pancreatitis (HTG-AP), focusing on early elimination of triglycerides.

    Alcohol Intervention

    • Alcohol abstinence is important in alcoholic pancreatitis to prevent recurrence.

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