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Most common cause of acute pancreatitis?
- Gallstones (MC)Q
- Alcohol (2nd MC)Q
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Drugs causing pancreatitis?
- Valproate
- Erythromycin
- Retrovirus
- Furesemide
- Azathioprine
- Tetracyclines
- Statins/Steroids/Sulfonamides
- Hydrochlorthiazides
- Estrogen
- Metronidazole
- Acetaminophen [VERy FAT SHEEMA suffered from pancreatitis]
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Non-Pancreatic causes of Hyperamylasemia?
- • Burns
- • Pregnancy
- • CholecystitisQ
- • Aortic aneurysmQ
- • Ruptured ectopic
- • Diabetic ketoacidosis
- • Renal transplantationQ
- • Perforated Ulcer, • Intestinal obstructionQ
- • Chronic liver diseaseQ, • Renal failureQ
- • Drugs: MorphineQ
- • Salivary Gland Disorders: Mumps, Calculus, Maxillofacial surgeryQ
- • Tumors: Carcinoma of the Lung, Esophagus, Breast, Ovary (LEBO)Q
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• MC cause of death in this group of patients with acute pancreatitis?
Multiorgan dysfunction syndromeQ.
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First sign of Multi-system organ failure in AP?
Impaired lung function caused by ARDSQ.
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Mortality in AP?
- • First 2 weeks (early phase): Multiorgan dysfunctionQ
- • After 2 weeks (late period): Septic complicationsQ
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Most common cause of pancreatitis in pediatric patients?
- Abdominal blunt trauma
- Systemic diseasesQ
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What is Fox signQ?
Inguinal ecchymosis in acute pancreatitis
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Which is more specific marker for Acute pancreatiis?
- Lipase is also a more specific marker of APQ because serum amylase levels can be elevated in a number of conditions.
- Amylase’s serum half-life is shorter as compared with lipase.
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What is sentinel loop sign? Q
Localized ileus of duodenum and proximal jejunum
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What is Colon cut off sign Q?
Localized ileus in transverse colon up to its mid point
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NSAIDs of choice in AP?
MetamizoleQ
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Opiate of choice in Acute pancreatitis?
BuprenorphineQ
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Definition of severe acute pancreatitis?
- APACHE II ≥ 8
- Ranson ≥ 3
- CRP level ≥130 mg/mLQ
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How many parameters are there in APACHE II?
- 12 parameters
- Vitals (BP, Temp, Pulse, RR), GCS, Hematocrit, WBC, Sodium, Potassium, Cr, Oxygenation, Ph
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What is APACHE-O?
Addition of Obesity in APACHE
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Modified CT severity index?
- Inflammation – 4
- Necrosis – 4
- Local complications – 2
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Indications for Operative Treatment in Acute Pancreatitis?
- • Failure of non-operative management with at least 48 hours of maximal ICU supportQ
- • Infected necrosisQ
- • Extravisceral airQ
- • Hemorrhage uncontrolled by interventional techniqueQ
- • Colonic complicationsQ
- • Operation is indicated for documented infection or for sterile pancreatic necrosisQ with persistent systemic illness.
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Radiological features of Acute pancreatitis?
- • Renal halo signQ
- • Gasless abdomenQ
- • Ground glass appearanceQ
- • Colon cut off signQ
- • Sentinel loopQ
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Radiological features of chronic pancreatitis?
- • Chain of lakes appearanceQ
- • String of pearl appearanceQ
- • Beaded appearanceQ
- • Numerous irregular calcificationsQ are pathognomonic (on X-ray)
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Radiological features of carcinoma pancreas?
- • Double contour of medial border of duodenal C loop
- • Double duct signQ
- • Dilated / widening of duodenal C loopQ
- • Mucosal irregularityQ
- • Scrambled egg appearance
- • Inverted / reverse 3 sign of FrostbergQ
- • Rose thorning of medial wall of 2nd part of duodenumQ
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MC affected vessel in acute pancreatitis?
- Splenic artery (pseudoaneusysm formation)Q
- Other vessels: Superior mesenteric, cystic, and gastroduodenal arteriesQ
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MC affected vessel leading to vascular thrombosis caused by acute pancreatitis?
Splenic veinQ
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Etiology of pseudoaneurysm formation in acute pancreatitis?
Pancreatic elastase damages the vessels
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Most common metabolic complication of acute pancreatitis?
HypocalcemiaQ.
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Antibiotic of choice for necrotic pancreatitis?
Carbapenems (imipenam and meropenam)Q
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Mortality rate after open necrosectomy?
25-30%
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Genes involved in pancreatitis?
- Hereditary Pancreatitis - PRSS1Q (Cationic trypsinogen) gene
- Idiopathic chronic Pancreatitis• CFTRQ
- Tropical (Nutritional) calcific Pancreatitis• SPINK1 (PTSI)Q
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Type of Stone in chronic pancreatitis?
Calcium carbonate crystalsQ
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TIGAR-O system consists of ?
Toxic-metabolic, idiopathic, genetic, autoimmune, recurrent severe, obstructive
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MC symptom of Chronic pancreaitis?
Abdominal pain
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What is Rosemont criteriaQ?
Criteria on EUS required to diagnose chronic pancreatitis
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Definition of Steatorrhea?
If the stool fat content exceeds 7 gm/dayQ
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Treatment options based on pancreatic duct diameter?
- Diameter >7 mm - decompressing procedure
- Normal pancreatic duct - resectional procedure
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Factors known to influence the outcome of a Pancreatic Anastomosis?
- • Texture of the pancreatic remnantQ
- • Caliber of the main pancreatic ductQ
- • Exocrine pancreatic juice outputQ
- • Surgical technique applied
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Role of Octreotide in pancreatic fistula?
- Benefit of prophylactic octreotide in the prevention of pancreatic fistulaQ
- Role of octreotide, once a fistula is established remains unclearQ
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Which part of pancreas is considered as pacemaker of chronic pancreatitisQ?
Pancreatic head - resection of pancreatic head has been shown to completely relieve the pain of chronic pancreatitis in 70-80%Q patients
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Drainage procedure for chronic pancreatitis?
- • Puestow ProcedureQ (Longitudinal Pancreaticojejunostomy): Resection of the tail followed by a longitudinal pancreaticojejunostomyQ
- • Partington and Rochelle Modification of Puestow Procedure: Elimination of the resection of the pancreatic tailQ.
- • Duval Procedure: Distal pancreatectomy with Roux-en-Y pancreaticojejunostomy (caudal PJ)Q
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Resection procedure for chronic pancreatitis?
- • Beger’s Procedure (Duodenal Preserving Pancreatic Head Resection DPPHRQ)
- • Warren’s modification of Beger’s procedure
- • Frey’s Procedure (Local Resection of the Head of the Pancreas Combined with Longitudinal Pancreaticojejunostomy LR-LPJ)Q
- • Berne modification: (Combines some aspects of Beger’s and Frey’s)
- • Hamburg modification of Frey’s
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Surgical Procedures in Chronic Pancreatitis in various conditions?
- • Ideal procedure for CP?
- : DPPHRQ (Beger’s)
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• Surgical procedure in presence of portal vein thrombosis?
Frey’sQ
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Surgical procedure in small duct disease?
V-shaped excision
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Pain management in CP not managed by analgesics?
Celiac plexus nerve blocksQ
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MC complication of chronic pancreatitisQ?
Pseudocyst. Pseudocyst may be present anywhere from mediastinum to the scrotumQ
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Investigation of choiceQ for diagnosis of a pancreatic pseudocyst?
CECT abdomen
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Indication of drainage of Pseudocyst of pancreas?
- >5 cm diameter
- Suspicion of infection
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Most common complication of pseudocyst pancreas?
Infection
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Most common artery involved in Pseudoaneurysm associated with Pancreatic Pseudocyst?
- • Splenic artery (30-50%): Most commonQ
- • Gastroduodenal artery (10-15%)
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