Master the board step 3

Gastroenterology
Other symptoms include:
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Vomiting without blood
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Anorexia
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Tenderness in the epigastric area
Severe cases involve these symptoms:
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Hypotension
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Metabolic acidosis
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Leukocytosis
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Hemoconcentration
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Hyperglycemia
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Hypocalcemia caused by fat malabsorption
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Hypoxia
Diagnostic Testing
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Best initial test: Amylase and lipase (Lipase has higher specificity.)
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Most accurate test: Abdominal CT scan. A CT scan can detect dilated common
bile ducts and even comment on intrahepatic ducts.
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Magnetic resonance cholangiopancreatography (MRCP) detects causes of
biliary and pancreatic duct obstruction not found on a CT scan.
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If there is dilation of the common bile duct without a pancreatic head mass,
consider endoscopic retrograde cholangiopancreatography (ERCP). The
ERCP can be used to detect the presence of stones or strictures in the pancreatic
duct system. ERCP can also remove stones and dilate strictures. ERCP
is predominantly a therapeutic tool.
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Trypsinogen activation peptide: This is a urinary test that can be used to
determine the severity of pancreatitis. Pancreatitis seems to arise from the
premature activation of trypsinogen while it is still within the pancreas
instead of when it reaches the duodenum. Hence, the trypsin starts to digest
and inflame the pancreas.
Treatment
Therapy consists of the following:
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No feeding (bowel rest)
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Hydration
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Pain medications
Acute Pancreatitis
• Diagnose with
ultrasound, CT, and
MRCP.
• Treat with ERCP.
We do not have a medication to reverse pancreatitis.
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