Acute Pancreatitis Overview
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Acute Pancreatitis Overview

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Questions and Answers

What percentage of acute pancreatitis cases are considered idiopathic after inconclusive work-ups?

  • 15-20% (correct)
  • 25-30%
  • 30-35%
  • 5-10%

    • Which enzyme is primarily responsible for digesting protein in the pancreas?

  • Trypsin (correct)
  • Elastase
  • Lipase
  • Amylase

    • What is the normal range for serum amylase levels?

  • 115-350 mg/ml
  • 19-86 U/L (correct)
  • 7-59 U/L
  • 25-100 mg/dL

    • Which of the following is a common clinical manifestation of acute pancreatitis?

    <p>Severe, relentless, knifelike pain</p> Signup and view all the answers

    Which variable is NOT part of the BISAP scoring system for assessing acute pancreatitis severity?

    <p>Body temperature &gt; 100.4°F</p> Signup and view all the answers

    What is a key diagnostic marker for pancreatitis in serum levels that is often more sensitive than amylase?

    <p>Serum lipase</p> Signup and view all the answers

    Which symptom is associated with fluid volume deficit in patients with acute pancreatitis?

    <p>Decreased urine output</p> Signup and view all the answers

    Which imaging technique is most commonly used to identify characteristic findings in acute pancreatitis?

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

    What is the primary reason for ensuring pain treatment in patients with acute pancreatitis?

    <p>It reduces exocrine enzyme release.</p> Signup and view all the answers

    Which feeding method is often preferred to prevent pancreatic stimulation in patients with moderate pancreatitis?

    <p>Enteral nutrition with jejunal feedings</p> Signup and view all the answers

    When might total parenteral nutrition (PN) be necessary in managing pancreatitis?

    <p>When enteral feeding is not tolerated</p> Signup and view all the answers

    Which of the following is a diagnostic test for assessing pancreatitis?

    <p>HbA1c</p> Signup and view all the answers

    What is a common local complication in acute pancreatitis that may require intervention?

    <p>Fluid accumulation in and around the pancreas</p> Signup and view all the answers

    Which statement is true regarding the use of opiates in patients with acute pancreatitis?

    <p>Opiates are generally discouraged.</p> Signup and view all the answers

    What does neuropathy in vascular problems associated with pancreatitis lead to?

    <p>Impaired sensation and weakness</p> Signup and view all the answers

    What might be a consequence of either too much or too little hormone in the context of pancreatitis?

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

    Which of the following parameters indicates a systemic inflammatory response syndrome when present?

    <p>Decreased PaO2 &lt; 60 mmHg</p> Signup and view all the answers

    What is the recommended initial management step for a patient with significant fluid losses?

    <p>Administration of IV isotonic crystalloid fluids</p> Signup and view all the answers

    A patient with a BISAP score of 5 has what percentage risk of mortality?

    <p>22%</p> Signup and view all the answers

    Which of the following findings is included in the criteria for calculating the BISAP score?

    <p>BUN &gt; 30 mg/dL</p> Signup and view all the answers

    What does a leukocyte count of < 4,000/microliters indicate in the context of systemic inflammatory response syndrome?

    <p>Systemic inflammatory response syndrome</p> Signup and view all the answers

    Which of the following signs may indicate retroperitoneal hemorrhage?

    <p>Cullen sign</p> Signup and view all the answers

    Which factor is NOT a common etiology for conditions leading to systemic inflammatory response syndrome?

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

    Patients with a score of 3 in the BISAP scoring system are associated with what level of hospital mortality?

    <p>15%</p> Signup and view all the answers

    What condition is described as excessive eating due to a lack of glucose entering the cells?

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

    Which of the following is a short-term complication of diabetes?

    <p>Diabetic ketoacidosis (DKA)</p> Signup and view all the answers

    What is a common cause of hypoglycemic shock?

    <p>Excess of insulin</p> Signup and view all the answers

    Which of the following indicates the severity of mild diabetic ketoacidosis (DKA)?

    <p>pH &lt; 7.30</p> Signup and view all the answers

    What is the expected manifestation of hypoglycemia affecting the CNS?

    <p>Confusion and slurred speech</p> Signup and view all the answers

    Which level of bicarbonate suggests moderate diabetic ketoacidosis (DKA)?

    <p>10-14 mEq/L</p> Signup and view all the answers

    What should be monitored in a patient with severe diabetic ketoacidosis?

    <p>Acidosis with pH &lt; 7.10</p> Signup and view all the answers

    Which symptom could indicate hypoglycemia stimulating the sympathetic nervous system?

    <p>Increased heart rate</p> Signup and view all the answers

    What is the appropriate action for Patient A after observing a blood glucose measurement decrease from 190 mg/dL to 110 mg/dL?

    <p>Decrease the insulin infusion rate</p> Signup and view all the answers

    For which patient should the insulin infusion rate remain unchanged based on their blood glucose levels?

    <p>Patient B with blood glucose of 110 mg/dL after previously being at 112 mg/dL</p> Signup and view all the answers

    What symptom is NOT associated with profound dehydration?

    <p>Improved skin turgor</p> Signup and view all the answers

    What is the recommended treatment for correcting hyperglycemia when blood glucose falls in the range of 250-300 mg/dL?

    <p>Give dextrose IV once blood glucose is in range</p> Signup and view all the answers

    When managing patients with high blood glucose levels, which fluid is primarily recommended for fluid replacement?

    <p>0.9% NaCl</p> Signup and view all the answers

    What is a key consideration when administering continuous IV insulin?

    <p>Check electrolyte levels frequently</p> Signup and view all the answers

    What does a blood glucose level above 600 mg/dL indicate about the patient's condition?

    <p>Possible diabetic ketoacidosis or hyperglycemic crisis</p> Signup and view all the answers

    Which of the following is a common neurological sign associated with severe hyperglycemia?

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

    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
    • 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)
    • 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.
    • 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
    • Risk Factors:
      • Chronic alcohol use
      • Gallstones/biliary tract disease
      • Less common factors include drug-induced (metronidazole, tetracycline, azathioprine, estrogens)
    • 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
    • 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
    • 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.

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