Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastro > Pancreatitis + Peritonitis > Flashcards

Pancreatitis + Peritonitis Flashcards

1
Q

S+S pancreatitis

A 
Epigastric/ LUQ pain 
N+V 
Steatorrhoea 
Jaundice
Tachycardia 
Cullen's sign = periumbilical bruising
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of pancreatitis

A 
Obstruction of bicarbonate secretion which activates pancreatic enzymes - leads to necrosis 
GET SMASHED
Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps
Autoimmune diseases eg SLE
Scorpion venom
Hypercalcaemia
ERCP
Drugs: azithioprine, NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations for pancreatitis

A

Secretin stimulation test
Raised lipase + amylase (diagnostic if 3x upper limit)
Bloods - AST + bilirubin raised, ALT raised if gallstones cause
ABG = metabolic acidosis.
Low Ca
AXR = perf, gas loops + calcification (sentinel loop sign)
CT with contrast if >48hrs
USS - for gallstones
ERCP for gallstones Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What scoring system is used to assess severity + prognosis of pancreatitis?

A

Glasgow + Ranson

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx for pancreatitis

A 
O2, fluids (Hartmanns)
Pain relief = NSAIDs/ morphine (PCA)
Abx (imipenem) 
Nutritional support - soft diet, low fat + residue, after 24hrs. Enteral nutrition for severe cases 
ERCP to remove gallstones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of pancreatitis

A

Pancreatic necrosis due to ischaemia - suspected if S+S last >7 days.
Acute necrotic collection or walled off necrosis (4 weeks)
Pancreatic pseudocyst (4 weeks)
Infected necrosis
Hypocalcaemia
Hyperglycaemia
Hypovolemic shock (due to 3rd space leakage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathology of pancreatitis

A

Pancreatic enzymes leak out of acinar cells to interstitial space + then to circulation
Causes acute elevation in pancreatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When can the diagnosis of pancreatitis be made?

A

2 of the following:
Acute onset severe epigastric pain
Elevation in lipase or amylase x3
Characteristic findings on imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is lipase better than amylase for diagnosing?

A

Lipase is more sensitive, elevations occur earlier + last longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two types of acute pancreatitis?

A

Edematous interstitial + necrotising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is pancreatitis graded (mild, mod + severe)?

A 
Mild = absence of organ failure + complications 
Moderate = no/ transient organ failure and/or local complications 
Severe = persistent organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of SBP

A 
Pts with cirrhosis who develop S+S:
Fever 
Abdo pain/ tenderness 
Altered mental status 
Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigation for SBP

A 
Paracentesis with analysis of fluid for:
Aerobic + anaerobic culture
PCR for DNA 
Cell count + differential
Gram stain 
Albumin
Protein
Glucose 
Lactate
Amylase
Bilirubin 
CEA
Alk phos

Bloods- FBC, serum creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is a diagnosis of SBP made?

A

When neutrophils in ascitic fluid are high + culture is positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference in management between SBP + secondary peritonitis?

A

SBP - abx

Secondary = abx + surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the relevance of the MELD score to SBP?

A

Higher the MELD score, more advanced the cirrhosis, higher risk of SBP

17
Q

Difference in presentation between SBP + peritonitis

A

SBP = no rigid abdo (ascites is between visceral + parietal surfaces)

18
Q

S+S of SBP

A

Fever, abdo pain/ tenderness, altered mental state
Diarrhea, paralytic ileus, hypotension, hypothermia
Peripheral leukocytosis, metabolic acidosis, azotemia

19
Q

Why is fever particularly significant in SBP?

A

Cirrhosis pts are usually hypothermic so temperature of 37.8 is significant

20
Q

What is the Reitan trail test?

A

diagnostic aid to detect subtle changes in mental state in pts with cirrhosis

21
Q

Which bacteria commonly cause SBP?

A

E coli + Klebsiella

Staph + strep less common

22
Q

What medication should be stopped in SBP?

A

Nonselective BB (propranolol + labetalol)

23
Q

Management of SBP before culture results

A

Cefotaxime (broad spectrum 3rd gen cephalosporin) or ciprofloxacin for 5 days

24
Q

What is the severe complication of SBP + how is it prevented?

A

Renal failure - occurs in 30-40%

Prevent with IV infusion of albumin

25
Q

What is used to prevent SBP?

A

Prophylactic abx in high risk pts

26
Q

What pts are deemed at high risk of getting SBP?

A

Pts with cirrhosis + GI bleeding
Pts with >1 episode of SBP
Pts with cirrhosis + ascites + renal/ liver failure

27
Q

What abx are used prophylactically to prevent SBP?

A

Trimethoprim or ciprofloxacin or ceftriaxone

28
Q

Pathology of chronic pancreatitis

A

Irreversible inflammation/ fibrosis of pancreas, due to alcohol misuse, drugs, idiopathic

29
Q

Complications of chronic pancreatitis

A

Chronic pain
Endocrine insufficiency - impaired glucose regulation + DM
Exocrine insufficiency - failure to produce digestive enzymes causing malabsorption + maldigestion
Pancreatic calcification
Pseudocyst formation

30
Q

Management of chronic pancreatitis

A

Supportive - enzyme supplements + steroids if autoimmune

31
Q

What is a subphrenic abscess?

A

Localised collections of infected fluid, causing chest + shoulder pain, fever, diarrea

32
Q

Investigations for ?subphrenic abscess

A

FBC, U+E, LFTs, blood cultures, peritoneal fluid analysis, urinalysis, AXR/ CXR/ US/ CT

33
Q

Pathology of liver abscesses

A

Commonly follow peritonitis due to leakage of bowel contents into portal circulation
Usually polymicrobial

34
Q

S+S liver abscess

A

Fever, pain, N+V, anorexia, weight loss

35
Q

Investigations for ?liver abscess

A

CT/ US, blood cultures

Aspiration + culture of abscess

36
Q

Management of liver abscess

A

Drainage (surgical or percutaneous)

Abx

37
Q

Types of peritonitis

A 
Primary = spontaneous 
Secondary = due to perforated viscus 
Tertiary = recurrent secondary

Gastro (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions