SONO 117 Hemodynamics GRADED A+ 2022

Differential diagnosis for Epigastric pain Peptic ulcer disease (most common reason for epigastric pain) Acute cholycystitis Acute pancreatitis Chronic pancreatitis Hemorrhagic pancreatitis Phlegmonous pancreatitis Pseudocyst Pancreatic carcinoma What is the most common reason for epigastric pain? Peptic ulcer disease Increased amylase and lipase are indicative of ________? pancreatitis Lab Values: Acute Pancreatitis high amylase and increasing lipase Lab Values: Chronic Pancreatitis higher lipase than amylase but both elevated Inflammation of pancreas causes Most common cause is billiary tract disease. Alcohol abuse PUD Trauma Pregnancy Drug use Infectious agents most common cause of inflammation of pancreas billiary tract disease Acute Pancreatitis: the result of damage to the ________ ______? acinar cells Acute Pancreatitis: When damage occurs ________ _______ are spilled out and _________ occurs. pancreatic enzymes inflammation What lab values increase with acute pancreatitis? amylase lipase leukocytosis Physical signs of acute pancreatitis sudden sever onset with nausea, pain, and distention of abdomen. who is acute pancreatitis more common in? men Complications of Acute Pancreatitis Pseudocyst Phlegmon Peritonitis Hemorrhage Obstruction of bowel Obstruction of hepatic ducts Most sever cases can result in heart, lung, or liver failure and even death Treatment for Acute Pancreatitis In many cases there is no treatment IV fluid to keep the patient hydrated TPN treatment (IV nutrition) may be needed for 3-6 weeks to give the pancreas time to heal if gallstones are the cause a cholecystectomy is indicated IV antibiotics if infection occurs If there is a hemorrhage of the pseudocyst or gland surgery may be indicated to drain the fluid Sonographic appearance of acute pancreatitis enlarged hypoechoic gland Chronic Pancreatitis: results from recurrent bouts of ______ _______. acute pancreatitis Chronic Pancreatitis: Continuous damage to the pancreas will cause ___________ and _________ ________ _________. This can result in a _________ ________ _________. fibrosis parenchyma cell death non functioning pancreas Chronic pancreatitis is more common in? men Chronic pancreatitis is caused by ______, ______% of the time. alcoholism 70% Physical symptoms of chronic pancreatitis. Often non symptomatic as the organ fails to function Can have bouts of pain radiating to the back, nausea, vomiting, jaundice. Pain after a meal, if a patient has chronic pancreas pain it can be debilitating. Complications of Chronic Pancreatitis Diabetes pseudocyst Portal or splenic vein occlusion Bile duct occlusion Treatment for Chronic Pancreatitis Pain medicine Surgery Diet changes Pancreatic enzyme replacement medication Periodic percutaneous drainage may be performed Technique for Pancreas NPO 8-12 hours This area can be very hard to visualize due to the c loop of the duodenum. If the pancreas is hard to visualize due to bowel gas having the patient drink water (through a straw to take out any air source) to use the stomach as a window can be an option. LLD or even RLD positions can also be helpful. Sonographic appearance Chronic Pancreatitis lipase levels are higher than amylase, a history of acute pancreatitis, the pancreas becomes small and fibrotic and hyperechoic. Sometime calculi can even be seen which are areas of densely calcified parenchyma. Sonographic appearance Acute Pancreatitis can look normal or enlarged and sonolucent, 40-60% of patients with acute pancreatitis have gallstones Sonographic appearance Hemorrhagic pancreatitis focal areas of fat necrosis or extravagated blood may be visualized within the pancreas. Patients hemorrhagic pancreatitis have high mortality rates When patients have discoloration on their flanks due to necrosis it is called Grey-Turners sign Pseudocysts occur in ___-___% of cases of Acute pancreatitis. 10-20%