Podcast
Questions and Answers
Which type of viral hepatitis typically has an incubation period around 30 days?
Which type of viral hepatitis typically has an incubation period around 30 days?
Which hepatitis virus is transmitted through both fecal-oral and parenteral routes?
Which hepatitis virus is transmitted through both fecal-oral and parenteral routes?
Which hepatitis type is associated with the highest percentage of fulminant cases?
Which hepatitis type is associated with the highest percentage of fulminant cases?
Which hepatitis virus was the first to be identified through electron microscopy?
Which hepatitis virus was the first to be identified through electron microscopy?
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Which type of Hepatitis is often referred to as "non-A, non-B hepatitis"?
Which type of Hepatitis is often referred to as "non-A, non-B hepatitis"?
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Which of these symptoms is NOT specifically associated with acute pancreatitis?
Which of these symptoms is NOT specifically associated with acute pancreatitis?
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What is the primary cause of damage to the pancreas in acute pancreatitis?
What is the primary cause of damage to the pancreas in acute pancreatitis?
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Which blood test is considered more specific for diagnosing acute pancreatitis?
Which blood test is considered more specific for diagnosing acute pancreatitis?
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Which of the following is NOT a recognized cause or risk factor for pancreatitis?
Which of the following is NOT a recognized cause or risk factor for pancreatitis?
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Which imaging technique is commonly used to diagnose acute pancreatitis?
Which imaging technique is commonly used to diagnose acute pancreatitis?
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Which of the following is NOT a primary goal of treatment for acute pancreatitis?
Which of the following is NOT a primary goal of treatment for acute pancreatitis?
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Which of these is NOT a commonly used medication to treat acute pancreatitis?
Which of these is NOT a commonly used medication to treat acute pancreatitis?
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What is the primary difference between acute and chronic pancreatitis?
What is the primary difference between acute and chronic pancreatitis?
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What is the primary treatment method for pain management in patients with chronic pancreatitis?
What is the primary treatment method for pain management in patients with chronic pancreatitis?
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Which symptom is NOT typically associated with chronic pancreatitis?
Which symptom is NOT typically associated with chronic pancreatitis?
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What is the pharmacological intervention for patients with autoimmune pancreatitis?
What is the pharmacological intervention for patients with autoimmune pancreatitis?
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Which of the following indicates a more serious approach to treatment in cases of suspected infection related to pancreatitis?
Which of the following indicates a more serious approach to treatment in cases of suspected infection related to pancreatitis?
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Which of the following is a common feature of portal hypertension?
Which of the following is a common feature of portal hypertension?
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What is a potential consequence of chronic pancreatitis if not managed properly?
What is a potential consequence of chronic pancreatitis if not managed properly?
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If pancreatic enzyme levels are too low, which pharmacological treatment is indicated?
If pancreatic enzyme levels are too low, which pharmacological treatment is indicated?
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Which of the following best describes the symptoms of chronic pancreatitis?
Which of the following best describes the symptoms of chronic pancreatitis?
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Flashcards
Hepatitis A Identification
Hepatitis A Identification
Identified by electron microscopy in 1973.
Icteric Phase
Icteric Phase
Phase where fever declines and symptoms improve.
Transmission Hepatitis A
Transmission Hepatitis A
Primarily fecal-oral transmission.
Mean Incubation Periods
Mean Incubation Periods
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Convalescent Phase
Convalescent Phase
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Pancreatitis
Pancreatitis
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Acute Pancreatitis
Acute Pancreatitis
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Chronic Pancreatitis
Chronic Pancreatitis
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Causes of Acute Pancreatitis
Causes of Acute Pancreatitis
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Symptoms of Acute Pancreatitis
Symptoms of Acute Pancreatitis
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Diagnosis of Acute Pancreatitis
Diagnosis of Acute Pancreatitis
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Treatment Goals for Acute Pancreatitis
Treatment Goals for Acute Pancreatitis
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Investigative Tests
Investigative Tests
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Anti-emetics
Anti-emetics
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Chronic pancreatitis symptoms
Chronic pancreatitis symptoms
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Viral hepatitis types
Viral hepatitis types
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Management of portal hypertension
Management of portal hypertension
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Pain management in chronic pancreatitis
Pain management in chronic pancreatitis
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Artificial digestive enzymes
Artificial digestive enzymes
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Hippocrates and jaundice
Hippocrates and jaundice
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Symptoms of hepatitis
Symptoms of hepatitis
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Study Notes
Pancreatitis
- Inflammation of pancreatic parenchyma
- Types:
- Acute:
- Reversible emergency condition
- Activated pancreatic enzymes leak into the pancreas, causing auto-digestion
- Elevated pancreatic enzymes in blood and urine
- Chronic:
- Permanent and irreversible damage
- Chronic inflammation, fibrosis, and destruction of exocrine and endocrine tissues
- Acute:
Causes of Pancreatitis
- Biliary tract diseases (gallstones)
- Alcohol intake
- Drugs (steroids, diuretics, valproic acid)
- Hypertriglyceridemia/hypercalcemia
- Idiopathic
- Traumatic injury (operative)
- Scorpion sting
Acute Pancreatitis
- Causes: Duct obstruction, acinar cell injury, defective intracellular transport
- Mechanisms: Cholelithiasis, ampullary obstruction, chronic alcoholism, ductal concretions, impaired blood flow, ischemia, alcohol, drugs, trauma, and viruses
- Release of intracellular proenzymes and lysosomal hydrolases
- Activation of enzymes (intra- or extracellular)
- Lesions: Interstitial inflammation, edema, proteolysis (proteases), fat necrosis (lipase, phospholipase), hemorrhage (elastase)
Acute Pancreatitis Stages
- Two phases: Early (1st week), Late (after 1st week)
- Severity: Mild (no organ failure), Moderate (organ failure < 48 hours), Severe (organ failure > 48 hours)
- Two types: Oedematous, Necrotizing
- Complications: Acute peripancreatic collection (< 4 wk), Acute necrotic collection (< 4 wk), Pseudocyst (> 4 wk), walled-off necrosis (> 4 wk)
Acute Pancreatitis - Symptoms
- Upper abdominal pain (sudden onset, sharp, severe, & continuous)
- Generalized abdominal pain
- Nausea, vomiting, and anorexia
- Fever and weakness
- Grey Turner's sign
- Cullen's sign
- Fox's sign
- Panniculitis (subcutaneous red nodular fat necrosis)
Acute Pancreatitis - Investigations
- Blood tests:
- Serum amylase (elevated for 3-5 days)
- Serum lipase (more pancreatic specific, elevated for 7 days)
- CBC, CRP
- Imaging tests:
- Chest X-ray
- Abdominal ultrasound
- CT scan
- MRI
- ERCP (Endoscopic retrograde cholangiopancreatography)
Acute Pancreatitis - Treatment
-
Treatment goals:
- Supportive care
- Decrease inflammation
- Limit risk of superinfections
- Identify and treat complications
- Treat cause (if possible)
-
Specific treatment
- Anti-emetics (IV)
- Opioid analgesics (IM pethidine)
- NPO (nil per OS) until pain free (2-3 days)
- Omeprazole or ranitidine (IV)
- Antisecretory drugs (somatostatin- octreotide)
- Respiratory support (O2 mask)
- Aggressive fluid rehydration (IV fluids)
- Antibiotic therapy (Carbapenem – Fluroquinolones)
- (only if needle aspiration of necrotic material confirms infection)
Chronic Pancreatitis - Symptoms
-
Pain in upper abdomen
-
Diarrhea
-
Fatty stools (loose, pale, don't flush away easily)
-
Nausea and vomiting
-
Shortness of breath
-
Unexplained weight loss
-
Excessive thirst and fatigue
-
Diagnosis: Similar to acute pancreatitis cases
-
Pharmacological treatment:
- Analgesics
- Artificial digestive enzymes (if enzyme levels are too low to digest food normally)
- Insulin (if complicated with diabetes)
- Steriods (if autoimmune pancreatitis)
Viral Hepatitis
- Features and classification of various types
- Management and pharmacological mechanisms of antiviral treatments
- Types of portal hypertension and their symptoms
- Pharmacological management of portal hypertension
Viral Hepatitis - Historical View
- 500 BC: Written accounts of jaundice in Babylonia
- 400 BC: Hippocrates describes "epidemic jaundice"
- 1941: Post-vaccination jaundice in >28K US soldiers
- 1947: Hepatitis A and hepatitis B designation
- 1963: Hepatitis B Surface Antigen identified
- 1973: Hepatitis A identified by electron microscopy
- Mid-1970s: Hepatitis D recognized
- Mid-1970s: Non-A, Non-B hepatitis described
- Mid-1980s: Epidemics of "non-hepatitis A" enteric hepatitis
- 1989: Hepatitis C cloned and serological tests developed
- 1990: Hepatitis E cloned and characterized
Viral Hepatitis - Common Features
- Early prodromal phase (2-3 weeks before jaundice): Arthralgias, arthritis, rash, angioneurotic edema, fever
- Preicteric phase: Gastrointestinal symptoms, malaise, myalgias, headache, fever
- Icteric phase: Fever declines, constitutional symptoms improve
- Convalescent phase: Full recovery usually within 6 months
Viral Hepatits - Differential Features (Table)
- Presents data in table format comparing various types of Hepatitis based on incubation period, transmission modes, and other aspects
Viral Hepatitis - Management
- Prophylaxis through vaccination:
- Hepatitis A Virus (HAV):
- Havrix, Vaqta
- Inactive (killed) HAV
- Two doses
- Recommended for travelers to HAV-endemic areas, illegal drug users, HAV lab researchers
- Hepatitis B Virus (HBV):
- Energix B, Recombivax-HB
- Harmless HBV surface antigen
- Three doses
- Recommended for infants and adolescents, people exposed to blood/body fluids, patients with kidney dialysis, and travelers to risk areas
- Hepatitis C/D Virus (HCV/HDV):
- No vaccines currently available
- Hepatitis A Virus (HAV):
Viral Hepatitis - Treatment
- HAV, HEV: Supportive care (unless complications arise)
- HBV (Acute): Supportive care, antiviral therapy only with liver failure, avoid interferon (increased risk of hepatic necroinflammation)
- HBV (Chronic): Antiviral therapy (Interferon-alpha, either standard or pegylated) is cornerstone.
- HCV (Acute): Pegylated interferon-alpha OR Antiviral therapy, treatment can be postponed for 12 weeks if viral load spontaneously clears
- HCV (Chronic): Antiviral therapy is cornerstone; antiviral selection depends on genotype; pegylated interferon-alpha may be used.
Viral Hepatitis - Antiviral Therapy (Details)
- HBV Therapies:
- Interferons (inducible glycoproteins, PEG-interferon) - mechanisms not fully understood
- Lamivudine (nucleoside analogue, HBV reverse transcriptase inhibitor) - High resistance rates
- Adefovir (nucleotide analogue)- Nephrotoxicity
- Entecavir (nucleoside analogue targeting HBV reverse transcriptase)- adjust dose in renal failure
- HCV Therapies:
- NS3/NS4A protease inhibitors (e.g., Paritaprevir, Grazoprevir, Glecaprevir, Voxilaprevir)
- NS5B polymerase inhibitors (e.g., Sofosbuvir, Dasabuvir)
- NS5A replication complex inhibitors (e.g., Ledipasvir, Ombitasvir, Elbasvir, Daclatasvir)
- Ribavirin (guanosine analogue, improves viral clearance, decreases relapse rates)
Portal Hypertension
- Portal venous pressure: Blood pressure in hepatic portal vein (5-10 mmHg)
- Portal hypertension: Hepatic venous pressure > 10 mmol/L
- Types:
- Pre-hepatic: Portal vein thrombosis (common), Pancreatitis
- Intra-hepatic: Cirrhosis, fibrosis, fatty liver, malignancy
- Post-hepatic: Hepatic vein thrombosis (Budd-Chiari syndrome), right heart failure
Portal Hypertension - Clinical Manifestations
- Ascites
- Hypersplenism
- Hemorrhoids
- Caput medusae (distended and engorged superficial epigastric veins)
- Esophageal varices
- Gynecomastia
- Jaundice
Portal Hypertension - Pharmacotherapy
-
Beta-blockers: (propranolol, nadolol, timolol)
- Decrease cardiac output → decrease portal flow
- Decrease splanchnic vasoconstriction → decrease portal flow.
- treatment of choice - continue for life.
-
Vasopressors: (e.g., vasopressin, somatostatin, octreotide):
- Control variceal bleeding through vasoconstrictive effects on blood vessels.
- Mediated through V1 receptors.
- Treat acute bleeding, IV octreotide decrease portal BP by splanchnic artery constriction reducing portal blood flow.
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Description
Test your knowledge on pancreatitis, its types, causes, and mechanisms. This quiz covers both acute and chronic pancreatitis, including factors that contribute to the condition. Challenge yourself to identify important aspects of pancreatic inflammation and damage.
