Podcast
Questions and Answers
What is the primary cause of pain associated with acute pancreatitis?
What is the primary cause of pain associated with acute pancreatitis?
Which two signs are classic findings in a physical examination for acute pancreatitis?
Which two signs are classic findings in a physical examination for acute pancreatitis?
What typically triggers the onset of acute pancreatitis most frequently?
What typically triggers the onset of acute pancreatitis most frequently?
What is the role of trypsin in the pathology of acute pancreatitis?
What is the role of trypsin in the pathology of acute pancreatitis?
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What is a common symptom that patients with acute pancreatitis experience?
What is a common symptom that patients with acute pancreatitis experience?
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What may complicate the diagnosis of acute pancreatitis?
What may complicate the diagnosis of acute pancreatitis?
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How does necrosis and blood spread in cases of acute pancreatitis?
How does necrosis and blood spread in cases of acute pancreatitis?
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What happens when the flow of pancreatic enzymes is blocked in acute pancreatitis?
What happens when the flow of pancreatic enzymes is blocked in acute pancreatitis?
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What is a rare cause of acute pancreatitis related to infections?
What is a rare cause of acute pancreatitis related to infections?
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Which of the following medications is known to potentially cause acute pancreatitis?
Which of the following medications is known to potentially cause acute pancreatitis?
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How does hypertriglyceridemia contribute to acute pancreatitis?
How does hypertriglyceridemia contribute to acute pancreatitis?
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What is the typical triglyceride level that can lead to acute pancreatitis?
What is the typical triglyceride level that can lead to acute pancreatitis?
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Which of the following conditions involves IgG4 plasma cells and can lead to recurrent acute pancreatitis?
Which of the following conditions involves IgG4 plasma cells and can lead to recurrent acute pancreatitis?
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What benign animal venom is associated with triggering acute pancreatitis?
What benign animal venom is associated with triggering acute pancreatitis?
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What procedure uses both endoscopy and fluoroscopy to image the biliary tree?
What procedure uses both endoscopy and fluoroscopy to image the biliary tree?
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What potential complication can arise from performing an E-R-C-P?
What potential complication can arise from performing an E-R-C-P?
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What bodily response is directly triggered by calcium deposition in pancreatic ducts?
What bodily response is directly triggered by calcium deposition in pancreatic ducts?
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What triggers the activation of trypsinogen into trypsin in the small intestine?
What triggers the activation of trypsinogen into trypsin in the small intestine?
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In children, which type of trauma is more likely to result in acute pancreatitis?
In children, which type of trauma is more likely to result in acute pancreatitis?
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Which enzyme is more specific for pancreatic damage in cases of acute pancreatitis?
Which enzyme is more specific for pancreatic damage in cases of acute pancreatitis?
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What role do chylomicrons play in the mechanism of triglyceride-related pancreatitis?
What role do chylomicrons play in the mechanism of triglyceride-related pancreatitis?
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Which of the following statements regarding autoimmune pancreatitis is FALSE?
Which of the following statements regarding autoimmune pancreatitis is FALSE?
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Which combination of symptoms is sufficient to diagnose acute pancreatitis?
Which combination of symptoms is sufficient to diagnose acute pancreatitis?
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What is a common laboratory finding in a patient with acute pancreatitis due to gallstones?
What is a common laboratory finding in a patient with acute pancreatitis due to gallstones?
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What characteristic imaging finding is typically seen in patients with autoimmune pancreatitis?
What characteristic imaging finding is typically seen in patients with autoimmune pancreatitis?
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What is a common trigger for acute pancreatitis that involves the use of chemotherapy?
What is a common trigger for acute pancreatitis that involves the use of chemotherapy?
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What can result from auto-activation of trypsin in the pancreas?
What can result from auto-activation of trypsin in the pancreas?
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What imaging technique can show necrosis of the pancreas in acute pancreatitis?
What imaging technique can show necrosis of the pancreas in acute pancreatitis?
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Which factor is NOT typically a cause of acute pancreatitis?
Which factor is NOT typically a cause of acute pancreatitis?
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What is the effect of gallstones on pancreatic enzyme flow?
What is the effect of gallstones on pancreatic enzyme flow?
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How many criteria are needed to diagnose acute pancreatitis?
How many criteria are needed to diagnose acute pancreatitis?
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Which pancreatic enzyme is involved in the activation of other enzymes after trypsin?
Which pancreatic enzyme is involved in the activation of other enzymes after trypsin?
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What does a high level of alkaline phosphatase indicate in a patient with acute pancreatitis due to gallstones?
What does a high level of alkaline phosphatase indicate in a patient with acute pancreatitis due to gallstones?
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Which of the following can occur due to increased lipase levels in the context of acute pancreatitis?
Which of the following can occur due to increased lipase levels in the context of acute pancreatitis?
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What dietary behavior is commonly associated with a risk of acute pancreatitis?
What dietary behavior is commonly associated with a risk of acute pancreatitis?
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In which imaging technique is edema of the pancreas typically identified?
In which imaging technique is edema of the pancreas typically identified?
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What is the primary reason for administering NPO status in patients with acute pancreatitis?
What is the primary reason for administering NPO status in patients with acute pancreatitis?
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Which of the following is NOT part of the standard treatment regimen for acute pancreatitis?
Which of the following is NOT part of the standard treatment regimen for acute pancreatitis?
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What characterizes systemic inflammatory response syndrome (SIRS)?
What characterizes systemic inflammatory response syndrome (SIRS)?
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Which combination indicates a patient may have sepsis in the context of pancreatitis?
Which combination indicates a patient may have sepsis in the context of pancreatitis?
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What does Ranson's Criteria help to predict in patients with acute pancreatitis?
What does Ranson's Criteria help to predict in patients with acute pancreatitis?
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What is a characteristic feature of disseminated intravascular coagulation (DIC) related to acute pancreatitis?
What is a characteristic feature of disseminated intravascular coagulation (DIC) related to acute pancreatitis?
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What indicates the fluid leakage in ARDS is not due to high pressures in the heart?
What indicates the fluid leakage in ARDS is not due to high pressures in the heart?
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What is contained in a pancreatic pseudocyst?
What is contained in a pancreatic pseudocyst?
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Which condition can occur secondary to severe acute pancreatitis and involves respiratory failure?
Which condition can occur secondary to severe acute pancreatitis and involves respiratory failure?
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What is a key distinguishing feature of walled-off pancreatic necrosis compared to a pseudocyst?
What is a key distinguishing feature of walled-off pancreatic necrosis compared to a pseudocyst?
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What is a common feature seen on the x-ray of a patient with ARDS?
What is a common feature seen on the x-ray of a patient with ARDS?
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Which of the following is an indicator of a patient developing SIRS?
Which of the following is an indicator of a patient developing SIRS?
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When are pancreatic pseudocysts usually diagnosed?
When are pancreatic pseudocysts usually diagnosed?
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Which area is the most common location for a pancreatic pseudocyst?
Which area is the most common location for a pancreatic pseudocyst?
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In the context of acute pancreatitis, what does NPO status prevent?
In the context of acute pancreatitis, what does NPO status prevent?
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What is the consequence of a ruptured duodenal ulcer in relation to acute pancreatitis?
What is the consequence of a ruptured duodenal ulcer in relation to acute pancreatitis?
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What is a potential complication of a large pancreatic pseudocyst?
What is a potential complication of a large pancreatic pseudocyst?
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What physiological change occurs during disseminated intravascular coagulation (DIC)?
What physiological change occurs during disseminated intravascular coagulation (DIC)?
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What is a pancreatic abscess?
What is a pancreatic abscess?
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What is a common cause of infection in pancreatic abscesses?
What is a common cause of infection in pancreatic abscesses?
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Which of the following statements about Ranson's Criteria is accurate?
Which of the following statements about Ranson's Criteria is accurate?
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In cases of acute pancreatitis, significant fluid loss is primarily due to which physiological change?
In cases of acute pancreatitis, significant fluid loss is primarily due to which physiological change?
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What happens during the saponification process in fat necrosis?
What happens during the saponification process in fat necrosis?
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What vital electrolytes can be low due to fat necrosis in acute pancreatitis?
What vital electrolytes can be low due to fat necrosis in acute pancreatitis?
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What can severe acute pancreatitis potentially progress to?
What can severe acute pancreatitis potentially progress to?
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Which treatment may be required for patients with severe acute pancreatitis?
Which treatment may be required for patients with severe acute pancreatitis?
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What is a significant prognostic indicator of poor outcomes in acute pancreatitis?
What is a significant prognostic indicator of poor outcomes in acute pancreatitis?
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How long after the onset of acute pancreatitis does a pancreatic abscess typically occur?
How long after the onset of acute pancreatitis does a pancreatic abscess typically occur?
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Duodenal ulcers can lead to acute ______ if they rupture.
Duodenal ulcers can lead to acute ______ if they rupture.
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NPO status means that the patient should consume ______ or liquid.
NPO status means that the patient should consume ______ or liquid.
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Administering ______ is necessary due to significant fluid loss in pancreatitis.
Administering ______ is necessary due to significant fluid loss in pancreatitis.
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Patients with severe acute pancreatitis can develop a clinical syndrome known as ______.
Patients with severe acute pancreatitis can develop a clinical syndrome known as ______.
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One criterion for SIRS is an elevated ______ above 38.3 degrees Celsius.
One criterion for SIRS is an elevated ______ above 38.3 degrees Celsius.
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The heart rate must be above ______ to meet SIRS criteria.
The heart rate must be above ______ to meet SIRS criteria.
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The ______ is a criteria set that helps predict the prognosis in acute pancreatitis.
The ______ is a criteria set that helps predict the prognosis in acute pancreatitis.
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Disseminated intravascular coagulation (DIC) leads to a consumption of ______ factors.
Disseminated intravascular coagulation (DIC) leads to a consumption of ______ factors.
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ARDS presents as respiratory failure with ______.
ARDS presents as respiratory failure with ______.
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In ARDS, protein escapes from the vascular space into the ______.
In ARDS, protein escapes from the vascular space into the ______.
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Patients with acute pancreatitis may initially appear well but can ______ rapidly.
Patients with acute pancreatitis may initially appear well but can ______ rapidly.
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The white blood cell count must be increased above ______ in SIRS criteria.
The white blood cell count must be increased above ______ in SIRS criteria.
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A patient developing bleeding, elevated PT/PTT, and low platelet count may have developed ______.
A patient developing bleeding, elevated PT/PTT, and low platelet count may have developed ______.
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SIRS in pancreatitis indicates a patient with more ______ disease.
SIRS in pancreatitis indicates a patient with more ______ disease.
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Trypsin is secreted as an inactive enzyme called ______.
Trypsin is secreted as an inactive enzyme called ______.
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The brush border enzyme that activates trypsinogen is called ______.
The brush border enzyme that activates trypsinogen is called ______.
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In acute pancreatitis, increased levels of serum ______ and lipase can help in diagnosis.
In acute pancreatitis, increased levels of serum ______ and lipase can help in diagnosis.
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The most common causes of acute pancreatitis are ______ and alcohol consumption.
The most common causes of acute pancreatitis are ______ and alcohol consumption.
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Lipase is more ______ for pancreatic damage compared to amylase.
Lipase is more ______ for pancreatic damage compared to amylase.
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CT scans can show edema of the pancreas and ______ in patients with acute pancreatitis.
CT scans can show edema of the pancreas and ______ in patients with acute pancreatitis.
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To diagnose acute pancreatitis, at least ______ out of three criteria must be met.
To diagnose acute pancreatitis, at least ______ out of three criteria must be met.
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A gallstone lodging in the common bile duct can obstruct the flow of both bile and ______.
A gallstone lodging in the common bile duct can obstruct the flow of both bile and ______.
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Abnormal liver function tests can be seen if ______ are the cause of acute pancreatitis.
Abnormal liver function tests can be seen if ______ are the cause of acute pancreatitis.
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Symptoms of acute pancreatitis can include ______ pain, nausea, and vomiting.
Symptoms of acute pancreatitis can include ______ pain, nausea, and vomiting.
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Imaging studies often reveal ______ bile ducts in cases of gallstone-related pancreatitis.
Imaging studies often reveal ______ bile ducts in cases of gallstone-related pancreatitis.
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In severe acute pancreatitis, lipase levels will be very ______.
In severe acute pancreatitis, lipase levels will be very ______.
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Patients with acute pancreatitis may exhibit elevated ______ cell counts.
Patients with acute pancreatitis may exhibit elevated ______ cell counts.
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Alcohol consumption can sometimes trigger the release of ______ enzymes.
Alcohol consumption can sometimes trigger the release of ______ enzymes.
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The inflammation of the pancreas in acute pancreatitis leads to liquefactive necrosis and ________ of the pancreatic tissue.
The inflammation of the pancreas in acute pancreatitis leads to liquefactive necrosis and ________ of the pancreatic tissue.
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Patients with acute pancreatitis often experience epigastric pain that classically radiates to the ________.
Patients with acute pancreatitis often experience epigastric pain that classically radiates to the ________.
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Two classic physical exam findings in acute pancreatitis are Cullen's Sign and ________ Sign.
Two classic physical exam findings in acute pancreatitis are Cullen's Sign and ________ Sign.
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The blocked flow of pancreatic enzymes leads to the activation of large amounts of ________ in acute pancreatitis.
The blocked flow of pancreatic enzymes leads to the activation of large amounts of ________ in acute pancreatitis.
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Patients typically present with mild abdominal tenderness during a ________ exam for acute pancreatitis.
Patients typically present with mild abdominal tenderness during a ________ exam for acute pancreatitis.
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Among the common triggers for acute pancreatitis, ________ consumption is frequently identified.
Among the common triggers for acute pancreatitis, ________ consumption is frequently identified.
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The pathophysiology of acute pancreatitis can lead to the pancreas beginning to ________ itself.
The pathophysiology of acute pancreatitis can lead to the pancreas beginning to ________ itself.
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Cullen's Sign is described as hemorrhage under the skin located near the ________.
Cullen's Sign is described as hemorrhage under the skin located near the ________.
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Blunt or penetrating trauma can potentially damage the ______ and cause acute pancreatitis.
Blunt or penetrating trauma can potentially damage the ______ and cause acute pancreatitis.
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Infection causing pancreatitis is rare, but one classic cause is ______.
Infection causing pancreatitis is rare, but one classic cause is ______.
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Some medications such as GLP-1 agonists are known to potentially trigger acute ______.
Some medications such as GLP-1 agonists are known to potentially trigger acute ______.
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Toxins from certain arachnids and reptiles can lead to acute ______.
Toxins from certain arachnids and reptiles can lead to acute ______.
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Autoimmune pancreatitis involves the presence of ______ plasma cells.
Autoimmune pancreatitis involves the presence of ______ plasma cells.
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Hypercalcemia can rarely trigger acute pancreatitis by causing calcium deposits in pancreatic ______.
Hypercalcemia can rarely trigger acute pancreatitis by causing calcium deposits in pancreatic ______.
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A triglyceride level over ______ can potentially cause acute pancreatitis.
A triglyceride level over ______ can potentially cause acute pancreatitis.
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E-R-C-P stands for endoscopic retrograde ______.
E-R-C-P stands for endoscopic retrograde ______.
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One of the complications of ERCP is ______, which can arise from duct irritation.
One of the complications of ERCP is ______, which can arise from duct irritation.
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Toxins, such as those from the ______ spider, are known to trigger acute pancreatitis.
Toxins, such as those from the ______ spider, are known to trigger acute pancreatitis.
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Hypertriglyceridemia is characterized by elevated ______ levels in the blood.
Hypertriglyceridemia is characterized by elevated ______ levels in the blood.
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The procedure of ERCP is used for both imaging and therapy of ______ disorders.
The procedure of ERCP is used for both imaging and therapy of ______ disorders.
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During ERCP, contrast material is injected into the biliary tree to create a ______ for imaging.
During ERCP, contrast material is injected into the biliary tree to create a ______ for imaging.
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Patients with autoimmune pancreatitis often have ______ abdominal pain.
Patients with autoimmune pancreatitis often have ______ abdominal pain.
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In ARDS, the pulmonary capillary wedge pressure is ______, indicating fluid leakage is not due to high pressures in the heart.
In ARDS, the pulmonary capillary wedge pressure is ______, indicating fluid leakage is not due to high pressures in the heart.
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Pancreatic pseudocysts are characterized by being a walled-off collection of ______ and fluid.
Pancreatic pseudocysts are characterized by being a walled-off collection of ______ and fluid.
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Walled-off pancreatic necrosis contains necrotic ______, in contrast to the fluid found in pseudocysts.
Walled-off pancreatic necrosis contains necrotic ______, in contrast to the fluid found in pseudocysts.
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It takes approximately ______ weeks for granulation and fibrous tissue to form around the edema and fluid in a pseudocyst.
It takes approximately ______ weeks for granulation and fibrous tissue to form around the edema and fluid in a pseudocyst.
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Pseudocysts are usually diagnosed through ______, often CT scans or MRIs.
Pseudocysts are usually diagnosed through ______, often CT scans or MRIs.
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About ______% of patients with chronic pancreatitis develop pancreatic pseudocysts.
About ______% of patients with chronic pancreatitis develop pancreatic pseudocysts.
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The most common location for a pancreatic pseudocyst is in the ______ sac of the abdomen.
The most common location for a pancreatic pseudocyst is in the ______ sac of the abdomen.
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If a large pseudocyst ruptures, it can lead to inflammation called ______.
If a large pseudocyst ruptures, it can lead to inflammation called ______.
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Pancreatic abscess usually develops about ______ days into acute pancreatitis due to infection.
Pancreatic abscess usually develops about ______ days into acute pancreatitis due to infection.
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Fat necrosis can progress to involve fat surrounding the pancreas and lead to low ______ levels.
Fat necrosis can progress to involve fat surrounding the pancreas and lead to low ______ levels.
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Saponification is the process where free fatty acids bind to ______ and magnesium, pulling them out of the serum.
Saponification is the process where free fatty acids bind to ______ and magnesium, pulling them out of the serum.
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Acute pancreatitis can progress to multi-organ failure and ______.
Acute pancreatitis can progress to multi-organ failure and ______.
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Fat necrosis in acute pancreatitis is due to the action of pancreatic enzymes such as pancreatic ______.
Fat necrosis in acute pancreatitis is due to the action of pancreatic enzymes such as pancreatic ______.
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Persistent hypotension in severe pancreatitis may not improve despite the use of ______.
Persistent hypotension in severe pancreatitis may not improve despite the use of ______.
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Study Notes
Acute Pancreatitis Overview
- Acute pancreatitis is acute inflammation of the pancreas, causing liquefactive necrosis and hemorrhage of pancreatic tissue.
- Classic symptoms include epigastric pain radiating to the back, nausea, and vomiting.
- Differentiating acute pancreatitis from other GI disorders is challenging; pancreatic enzymes are often checked.
- Common triggers include gallstones and alcohol consumption.
- Physical exam findings are often nonspecific but may include mild abdominal tenderness.
Key Physical Exam Findings
- Cullen's Sign: Hemorrhage under the skin near the umbilicus.
- Grey Turner's Sign: Hemorrhage under the skin in the flank region.
Pathophysiology
- Blocked flow of pancreatic enzymes while synthesis continues leads to trypsin activation.
- Trypsin activates other enzymes (e.g., phospholipase, chymotrypsin, elastase), causing auto-digestion of the pancreas.
- Trypsin is secreted as trypsinogen and activated by enterokinase in the small intestine; activated trypsin can also activate more trypsin.
Diagnostic Approach
- Diagnosing acute pancreatitis involves checking serum pancreatic enzymes (amylase and lipase).
- Lipase is more specific for pancreatic damage; high levels are significant in severe cases.
- Liver function tests may be abnormal, particularly if gallstones are causing the pancreatitis.
- Elevated white blood cell count is also sometimes observed.
- Imaging (e.g., ultrasound, CT scan) may show gallstones, edema, necrosis, or bile duct dilation.
Diagnostic Criteria
- Epigastric pain
- Increased serum amylase/lipase (greater than three times the upper limit of normal)
- Abnormal pancreatic imaging (CT/MRI)
- Diagnosis requires at least two of the three criteria.
Etiology
- Gallstones: Gallstones obstructing the common bile duct block pancreatic enzyme flow to the duodenum.
- Alcohol Consumption: Unknown mechanism, frequently implicated in heavy drinkers.
Other Causes
- Idiopathic: No identifiable cause.
- Trauma: Blunt or penetrating trauma to the pancreas can trigger acute pancreatitis.
- Infection: Rarely, viral (mumps), bacterial, or parasitic infections can be a cause.
- Drugs: Certain drugs (GLP-1 agonists, sulfa drugs, 6-mercaptopurine) are associated with acute pancreatitis.
- Toxins: Arachnid and reptile venoms, such as brown recluse spider, scorpions, and Gila monster, trigger acute pancreatitis.
- Autoimmune pancreatitis: A rare condition involving IgG4 plasma cells; responds to steroids.
- Hypercalcemia: Calcium deposits in pancreatic ducts activate enzymes; leads to auto-digestion.
- Hypertriglyceridemia: Serum triglyceride levels exceeding 1000 mg/dL can lead to acute pancreatitis. Chylomicrons obstruct blood vessels and release free fatty acids.
- ERCP (Endoscopic Retrograde Cholangiopancreatography) Complications: Injury to pancreatic duct can trigger post-ERCP pancreatitis.
- Duodenal Ulcers: Rupture can lead to acute pancreatitis.
Complications
- Disseminated Intravascular Coagulation (DIC): Widespread clotting depletes coagulation factors, leading to bleeding and microangiopathic hemolytic anemia.
- Acute Respiratory Distress Syndrome (ARDS): Vascular damage results in fluid leakage into the lungs, leading to respiratory failure.
- Pancreatic Pseudocyst: Encapsulated collection of fluid and edema, often asymptomatic but can rupture. Locations include lesser sac of abdomen.
- Pancreatic Abscess: Infected pseudocysts; present with fever and clinical deterioration.
- Fat Necrosis: Release of free fatty acids, binding calcium; leads to low serum calcium levels.
- Multi-organ Failure: Severe acute pancreatitis can lead to systemic complications, including DIC, ARDS, infection, and shock; often requiring intensive care unit treatment.
Treatment
- NPO (Nil per os): Resting the pancreas.
- IV Fluids: Maintaining hydration and blood pressure.
- Pain Control: Managing epigastric pain.
Monitoring Criteria(e.g., Ranson's Criteria, APACHE II)
- Predict features at admission or within 48 hours that indicate severe disease potential.
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Description
Explore the key concepts of acute pancreatitis, including symptoms, triggers, and important physical exam findings. This quiz will help clarify the pathophysiology and diagnostic challenges associated with this condition. Test your knowledge of its clinical presentation and management.
