Pancreatitis
Two most common causes of Pancreatitis
Alcohol abuse and gallstones
Spleenomegaly, edema/ascites, and varices
Complications from portal hypertension
Daily Double:
Decreased systemic vascular resistant in what condition leads to what finding?
Pancreatitis and hypotension
Ranson criteria on admission?
Age > 55, WBC > 16, Glucose > 200, LDH > 350, AST > 250
Given to pull third-space fluid back into the circulation
Albumin
Plays a major role in autodigestion
Phospholipase A and Elastase
Portal Vein
Carries blood from stomach, intestines, spleen, gallbladder, and pancreas to liver
Bluish discoloration around umbilicus
Cullen's sign
Rises 2-12 hours after onset of pain
Amylase
Causes of Pruritus
Accumulation of bile salts
Causes fat necrosis
Phospholipase A
Causes of esophageal varices rupture
Anything that rapidly increases pressure - coughing, straining, vomiting, irritation from food/alcohol
Location of abdominal pain in pancreatitis
LUQ/Epigastric area
Sensitive/Specific lab for pancreatitis
Lipase
Given to help reduce portal pressure (ccute bleeding varices)
Octreotide
Enzyme activates other enzymes
Trypsin
Daily Double:
Most life-threatening complication of cirrhosis
Bleeding esophageal varices
Symptoms associated with pancreatitis
Ranson criteria at 48hrs?
Hct decreases > 10%, BUN rises > 5, Calcium < 8, PO2 < 60, fluid deficit > 6L
Lactulose
Given as treatment for hepatic encephalopathy
Usually resolves on its own within a week
Non-hemorragic/interstitial
Medication that causes acute liver failure
Tylenol/Acetaminophen
Jaundice
Due to decreased ability to break down bilirubin by liver cells
Elevates due to hemoconcentration
Hematocrit
Daily Double:
Ring of varices around the umbilicus
Caput medusae
Third Spacing?
Large volume losses of intravascular fluid into the abdomen and peritoneum
Daily Double:
Causes by strictures, pancreatitis and gallstones
Biliary cirrhosis
Findings associated with increased estrogen
Alterations in hair distribution (thick hair growth, facial hair) and gynecomastia
Islet cells not functioning properly results in
Hyperglycemia
To obtain dry weight in patient with moderate ascites
Subtract 5kg (subtract 10kg if severe)
Treatment that involves CT-guided drainage procedure
Pseudocyst or abscess
Diet order
2gm Na diet and fluid restriction
Side effect of lactulose
Diarrhea
Elevated due to build-up of nitrogenous waste
Ammonia
Another source of non-carbohydrate calories
Fat emulsion
Extrapancreatic inflammation associated with systemic complications
Hemorrhagic/necrotizing
Replaces needed clotting factors
FFP or Vitamin K
Involuntary tremors
Asterixs (seen with hepatic encephalopathy)
Live cell enzymes
AST, ALT, Alk Phos, Lactate and GGT (Gamma-glutamyl Transferase)
Daily Double:
Percentage of dextrose that must be infused through central vein and why
Greater than 10% due to high osmolarity