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Questions and Answers
What percentage of acute pancreatitis cases are considered idiopathic after inconclusive work-ups?
What percentage of acute pancreatitis cases are considered idiopathic after inconclusive work-ups?
Which enzyme is primarily responsible for digesting protein in the pancreas?
Which enzyme is primarily responsible for digesting protein in the pancreas?
What is the normal range for serum amylase levels?
What is the normal range for serum amylase levels?
Which of the following is a common clinical manifestation of acute pancreatitis?
Which of the following is a common clinical manifestation of acute pancreatitis?
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Which variable is NOT part of the BISAP scoring system for assessing acute pancreatitis severity?
Which variable is NOT part of the BISAP scoring system for assessing acute pancreatitis severity?
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What is a key diagnostic marker for pancreatitis in serum levels that is often more sensitive than amylase?
What is a key diagnostic marker for pancreatitis in serum levels that is often more sensitive than amylase?
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Which symptom is associated with fluid volume deficit in patients with acute pancreatitis?
Which symptom is associated with fluid volume deficit in patients with acute pancreatitis?
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Which imaging technique is most commonly used to identify characteristic findings in acute pancreatitis?
Which imaging technique is most commonly used to identify characteristic findings in acute pancreatitis?
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What is the primary reason for ensuring pain treatment in patients with acute pancreatitis?
What is the primary reason for ensuring pain treatment in patients with acute pancreatitis?
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Which feeding method is often preferred to prevent pancreatic stimulation in patients with moderate pancreatitis?
Which feeding method is often preferred to prevent pancreatic stimulation in patients with moderate pancreatitis?
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When might total parenteral nutrition (PN) be necessary in managing pancreatitis?
When might total parenteral nutrition (PN) be necessary in managing pancreatitis?
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Which of the following is a diagnostic test for assessing pancreatitis?
Which of the following is a diagnostic test for assessing pancreatitis?
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What is a common local complication in acute pancreatitis that may require intervention?
What is a common local complication in acute pancreatitis that may require intervention?
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Which statement is true regarding the use of opiates in patients with acute pancreatitis?
Which statement is true regarding the use of opiates in patients with acute pancreatitis?
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What does neuropathy in vascular problems associated with pancreatitis lead to?
What does neuropathy in vascular problems associated with pancreatitis lead to?
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What might be a consequence of either too much or too little hormone in the context of pancreatitis?
What might be a consequence of either too much or too little hormone in the context of pancreatitis?
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Which of the following parameters indicates a systemic inflammatory response syndrome when present?
Which of the following parameters indicates a systemic inflammatory response syndrome when present?
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What is the recommended initial management step for a patient with significant fluid losses?
What is the recommended initial management step for a patient with significant fluid losses?
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A patient with a BISAP score of 5 has what percentage risk of mortality?
A patient with a BISAP score of 5 has what percentage risk of mortality?
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Which of the following findings is included in the criteria for calculating the BISAP score?
Which of the following findings is included in the criteria for calculating the BISAP score?
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What does a leukocyte count of < 4,000/microliters indicate in the context of systemic inflammatory response syndrome?
What does a leukocyte count of < 4,000/microliters indicate in the context of systemic inflammatory response syndrome?
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Which of the following signs may indicate retroperitoneal hemorrhage?
Which of the following signs may indicate retroperitoneal hemorrhage?
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Which factor is NOT a common etiology for conditions leading to systemic inflammatory response syndrome?
Which factor is NOT a common etiology for conditions leading to systemic inflammatory response syndrome?
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Patients with a score of 3 in the BISAP scoring system are associated with what level of hospital mortality?
Patients with a score of 3 in the BISAP scoring system are associated with what level of hospital mortality?
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What condition is described as excessive eating due to a lack of glucose entering the cells?
What condition is described as excessive eating due to a lack of glucose entering the cells?
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Which of the following is a short-term complication of diabetes?
Which of the following is a short-term complication of diabetes?
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What is a common cause of hypoglycemic shock?
What is a common cause of hypoglycemic shock?
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Which of the following indicates the severity of mild diabetic ketoacidosis (DKA)?
Which of the following indicates the severity of mild diabetic ketoacidosis (DKA)?
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What is the expected manifestation of hypoglycemia affecting the CNS?
What is the expected manifestation of hypoglycemia affecting the CNS?
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Which level of bicarbonate suggests moderate diabetic ketoacidosis (DKA)?
Which level of bicarbonate suggests moderate diabetic ketoacidosis (DKA)?
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What should be monitored in a patient with severe diabetic ketoacidosis?
What should be monitored in a patient with severe diabetic ketoacidosis?
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Which symptom could indicate hypoglycemia stimulating the sympathetic nervous system?
Which symptom could indicate hypoglycemia stimulating the sympathetic nervous system?
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What is the appropriate action for Patient A after observing a blood glucose measurement decrease from 190 mg/dL to 110 mg/dL?
What is the appropriate action for Patient A after observing a blood glucose measurement decrease from 190 mg/dL to 110 mg/dL?
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For which patient should the insulin infusion rate remain unchanged based on their blood glucose levels?
For which patient should the insulin infusion rate remain unchanged based on their blood glucose levels?
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What symptom is NOT associated with profound dehydration?
What symptom is NOT associated with profound dehydration?
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What is the recommended treatment for correcting hyperglycemia when blood glucose falls in the range of 250-300 mg/dL?
What is the recommended treatment for correcting hyperglycemia when blood glucose falls in the range of 250-300 mg/dL?
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When managing patients with high blood glucose levels, which fluid is primarily recommended for fluid replacement?
When managing patients with high blood glucose levels, which fluid is primarily recommended for fluid replacement?
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What is a key consideration when administering continuous IV insulin?
What is a key consideration when administering continuous IV insulin?
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What does a blood glucose level above 600 mg/dL indicate about the patient's condition?
What does a blood glucose level above 600 mg/dL indicate about the patient's condition?
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Which of the following is a common neurological sign associated with severe hyperglycemia?
Which of the following is a common neurological sign associated with severe hyperglycemia?
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Study Notes
Acute Pancreatitis
- Cause: The body "autodigests" the pancreas, caused by the release of stored enzymes (trypsin, phospholipase A, amylase, elastase) within the pancreas instead of being excreted to the duodeum
- Pathophysiology: The pancreas normally has a protective mechanism with trypsin inhibitor to prevent enzyme activation before reaching the duodenum, but this mechanism fails in pancreatitis, leading to autodigestion
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Diagnosis: Requires two out of three criteria:
- Abdominal pain or epigastric pain (possibly radiating to the back)
- Serum amylase or lipase at least two to four times the normal range (Lipase is generally more sensitive)
- Characteristic findings on imaging (ultrasound is often used)
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BISAP Score: Used to assess severity based on five variables:
- BUN > 25 mg/dL
- Impaired mental status
- Polyphagia: Excessive eating due to a lack of glucose reaching the cells
- Decreased PaO2 (< 60 mmHg) and O2sat (< 90%)
- Pleural effusion on imaging
- Each variable scores 1 point.
- Scores of 3, 4, and 5 are associated with higher hospital mortality.
- Score of 5 carries a 22% mortality rate.
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Management:
- Fluid resuscitation: IV isotonic crystalloids to replace fluid losses due to third spacing, vomiting, and vascular permeability
- Pain Management: Opiates are generally discouraged, focus on positioning (knee-chest) and comfort
- Preventing Pancreatic Stimulation: Low fat, low residue oral feeding may be considered after 24-48 hours, but EN with jejunal feedings is often preferred
- Treating Local Complications: Percutaneous/stent therapies to drain fluids, surgical resection/debridement if pancreas becomes infected, biliary ERCP or laparoscopic cholecystectomy for gallstone pancreatitis
- Endocrine Disorders: Result from too much or too little hormone, with a diagnostic focus on fasting blood glucose, glucose tolerance, and HbA1c
- Vascular Problems: Neuropathy can lead to impaired sensation, numbness, tingling, weakness, and muscle wasting
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Risk Factors:
- Chronic alcohol use
- Gallstones/biliary tract disease
- Less common factors include drug-induced (metronidazole, tetracycline, azathioprine, estrogens)
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Clinical Manifestations:
- Acute Pain: Severe, relentless, knifelike, in the midepigastrium or periumbilical region
- Fluid Volume Deficit: Hypotension mental status changes, tachycardia, cool clammy skin, decreased urine output
- Impaired Gas Exchange:
- Abdominal Guarding: Rebound tenderness
- Vomiting and Nausea:
- Hypoactive Bowel Sounds:
Diabetes
-
Complications:
- Short-term: Hypoglycemic shock and diabetic ketoacidosis (DKA)
- Long-term: Result from long-term increased blood glucose
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Hypoglycemic Shock:
- Cause: Excessive insulin, leading to a glucose deficit
- Symptoms: Poor concentration, slurred speech, staggering, appearing intoxicated, increased heart rate, anxiety, tremors
- Management: Rapid-acting insulins (Humulin R)
- Insulin Management: Adjust insulin rates based on blood glucose levels to avoid hypoglycemia
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Diabetic Ketoacidosis (DKA)
- Cause: Lack of insulin leading to an inability to utilize glucose, the body attempts to use fat for energy, resulting in ketone production
- Symptoms: Frequent urination, thirst, rapid breathing, fruity breath odor, lethargy, confusion, coma, abdominal pain, nausea, vomiting
-
Severity:
- Mild: Glucose > 300 mg/dL, bicarbonate 15-18 mEq/L, pH < 7.30
- Moderate: pH < 7.20, bicarbonate 10-14 mEq/L, increasing drowsiness
- Severe: pH < 7.10, bicarbonate < 10 mEq/L, decreased levels of consciousness or coma
-
Management:
- Fluid replacement with 0.9% saline
- Electrolyte imbalances are corrected
- Insulin is administered at a slow continuous rate, with close monitoring of volume and electrolytes
- Prevention: "Sick Day Rules" to prevent episodes of DKA by managing blood glucose during periods of illness
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Description
This quiz focuses on the causes, pathophysiology, diagnosis, and assessment of acute pancreatitis. It covers criteria for diagnosis, including symptoms and laboratory findings, as well as the BISAP score for severity evaluation. Test your knowledge on this critical condition's underlying mechanisms and clinical implications.
