PANCE Blueprint GI and Nutrition (9%)

Disorders of the Pancreas (PEARLS)

The NCCPA™ Gastroenterology and Nutrition PANCE Content Blueprint covers acute and chronic pancreatitis under the category disorders of the pancreas

Acute and chronic pancreatitis
Patient will present as → a 37-year-old male complaining of rapid onset of severe mid-epigastric pain with radiation to the back after eating a large meal. The pain typically lessens when the patient leans forward or lies in the fetal position. Physical exam shows low-grade fever, epigastric tenderness, diminished bowel sounds, and bruising of the flanks. An abdominal CT scan shows localized dilation of the upper duodenum and a small collection of fluid in the left pleural cavity.

Acute Pancreatitis - epigastric abdominal pain with radiation to the back and elevated lipase

  • Etiology: Cholelithiasis or alcohol abuse
  • DX:
    • Clinical + elevated lipase and amylase
    • CT is required to differentiate from necrotic pancreatitis
  • Signs: Grey turner's sign (flank bruising), Cullen’s sign (bruising near umbilicus)

Hemorrhagic pancreatitis - Grey Turner's sign

This 40-year-old woman complained of worsening epigastric pain of five days duration. On examination, she had hypotension, a board-like abdomen, and extensive ecchymosis over her right loin (Grey Turner’s sign)

Cullen's sign

Acute pancreatitis with Cullen’s sign

Ranson’s criteria for poor prognosis:

At admit:

  • Age > 55
  • Leukocyte: >16,000
  • Glucose: >200
  • LDH: >350
  • AST: >250

At 48 hrs:

  • Arterial PO2: <60
  • HCO3: <20
  • Calcium: <8.0
  • BUN: Increase by 1.8+
  • Hematocrit: decrease by >10%
  • Fluid sequestration >6L

TX: IV fluids (best), analgesics, bowel rest

Complication: pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)

Chronic Pancreatitis - a classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus

  • Alcohol abuse
  • Treatment: No alcohol, low-fat diet
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