Most common cause of acute pancreatitis?
- Gallstones (MC)Q
- Alcohol (2nd MC)Q
Drugs causing pancreatitis?
- Acetaminophen [VERy FAT SHEEMA suffered from pancreatitis]
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
• MC cause of death in this group of patients with acute pancreatitis?
Multiorgan dysfunction syndromeQ.
First sign of Multi-system organ failure in AP?
Impaired lung function caused by ARDSQ.
Mortality in AP?
- • First 2 weeks (early phase): Multiorgan dysfunctionQ
- • After 2 weeks (late period): Septic complicationsQ
Most common cause of pancreatitis in pediatric patients?
- Abdominal blunt trauma
- Systemic diseasesQ
What is Fox signQ?
Inguinal ecchymosis in acute pancreatitis
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.
What is sentinel loop sign? Q
Localized ileus of duodenum and proximal jejunum
What is Colon cut off sign Q?
Localized ileus in transverse colon up to its mid point
NSAIDs of choice in AP?
Opiate of choice in Acute pancreatitis?
Definition of severe acute pancreatitis?
- APACHE II ≥ 8
- Ranson ≥ 3
- CRP level ≥130 mg/mLQ
How many parameters are there in APACHE II?
- 12 parameters
- Vitals (BP, Temp, Pulse, RR), GCS, Hematocrit, WBC, Sodium, Potassium, Cr, Oxygenation, Ph
What is APACHE-O?
Addition of Obesity in APACHE
Modified CT severity index?
- Inflammation – 4
- Necrosis – 4
- Local complications – 2
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.
Radiological features of Acute pancreatitis?
- • Renal halo signQ
- • Gasless abdomenQ
- • Ground glass appearanceQ
- • Colon cut off signQ
- • Sentinel loopQ
Radiological features of chronic pancreatitis?
- • Chain of lakes appearanceQ
- • String of pearl appearanceQ
- • Beaded appearanceQ
- • Numerous irregular calcificationsQ are pathognomonic (on X-ray)
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
MC affected vessel in acute pancreatitis?
- Splenic artery (pseudoaneusysm formation)Q
- Other vessels: Superior mesenteric, cystic, and gastroduodenal arteriesQ
MC affected vessel leading to vascular thrombosis caused by acute pancreatitis?
Etiology of pseudoaneurysm formation in acute pancreatitis?
Pancreatic elastase damages the vessels
Most common metabolic complication of acute pancreatitis?
Antibiotic of choice for necrotic pancreatitis?
Carbapenems (imipenam and meropenam)Q
Mortality rate after open necrosectomy?
Genes involved in pancreatitis?
- Hereditary Pancreatitis - PRSS1Q (Cationic trypsinogen) gene
- Idiopathic chronic Pancreatitis• CFTRQ
- Tropical (Nutritional) calcific Pancreatitis• SPINK1 (PTSI)Q
Type of Stone in chronic pancreatitis?
Calcium carbonate crystalsQ
TIGAR-O system consists of ?
Toxic-metabolic, idiopathic, genetic, autoimmune, recurrent severe, obstructive
MC symptom of Chronic pancreaitis?
What is Rosemont criteriaQ?
Criteria on EUS required to diagnose chronic pancreatitis
Definition of Steatorrhea?
If the stool fat content exceeds 7 gm/dayQ
Treatment options based on pancreatic duct diameter?
- Diameter >7 mm - decompressing procedure
- Normal pancreatic duct - resectional procedure
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
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
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
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
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
Surgical Procedures in Chronic Pancreatitis in various conditions?
- • Ideal procedure for CP?
- : DPPHRQ (Beger’s)
• Surgical procedure in presence of portal vein thrombosis?
Surgical procedure in small duct disease?
Pain management in CP not managed by analgesics?
Celiac plexus nerve blocksQ
MC complication of chronic pancreatitisQ?
Pseudocyst. Pseudocyst may be present anywhere from mediastinum to the scrotumQ
Investigation of choiceQ for diagnosis of a pancreatic pseudocyst?
Indication of drainage of Pseudocyst of pancreas?
- >5 cm diameter
- Suspicion of infection
Most common complication of pseudocyst pancreas?
Most common artery involved in Pseudoaneurysm associated with Pancreatic Pseudocyst?
- • Splenic artery (30-50%): Most commonQ
- • Gastroduodenal artery (10-15%)