ACNP Gastrointestinal- Questions and
Answers
PE findings in Pancreatitis Correct Ans-Upper abdomen tender to palpation, usually
WITHOUT guarding, rigidity, or rebound (helps r/o acute abdomen)
Distended abdomen
Absent bowel sounds
Fever
Tachycardia
Pallor, cool skin
Mild jaundice common
If hemorrhagic--Grey Turner's sign and Cullen's sign
Cullen's Sign Correct Ans-Umbilical discoloration, commonly seen in acute pancreatitis
Grey Turner's Sign Correct Ans-Flank discoloration, commonly seen in acute pancreatitis
Labs and Diagnostics of Acute Pancreatitis Correct Ans-WBC elevation: degree depends
upon severity
Hyperglycemia
Serum LDH and AST elevation
**Serum amylase (50-180) and lipase (14-280) elevated in 90% of cases
BUN and coags may be elevated
,Hypocalcemia, levels <7 may be associated with tetany; watch for Chvostek's sign and/or
Trousseau's sign
Elevated C-reactive protein suggests pancreatic necrosis
CT scan MORE useful than US
Ranson's Criteria
George
Washington
Got
Lazy
After
He
Broke
C-A-B-E Correct Ans-Used to evaluate prognosis (5-6 risk factors= 40% mortality; >7 risk
factors= approximately 100% mortality)
Signs at Admission:
1. Greater than 55 YO
2. WBCs >16,000
3. Glucose > 200
4. LDH >350
5. AST> 250
Signs during the 1st 48 hours:
1. Hct drop of >10
, 2. BUN increases >5
3. Calcium <8
4. Arterial O2 <60
5. Base deficit >4
6. Estimated fluid sequestration>6,000 mL
Management of Acute Pancreatitis Correct Ans-Ranson's Criteria
Bedrest
NPO
Aggresive IVF volume repletion
NG suction
Pain control
Once patient is pain free and has bowel sounds, may begin clear liquid diet
Bowel obstruction Correct Ans-Blockage of the lumen of the intestine that impedes passage
of gas and contents through the bowel
Major causes of Bowel Obstruction Correct Ans-1. Adhesion--look @ surgical hx for scar
tissues
2. Hernia
3. Volvulus
4. Tumors
5. Fecal Impaction--can lead to perforation
Answers
PE findings in Pancreatitis Correct Ans-Upper abdomen tender to palpation, usually
WITHOUT guarding, rigidity, or rebound (helps r/o acute abdomen)
Distended abdomen
Absent bowel sounds
Fever
Tachycardia
Pallor, cool skin
Mild jaundice common
If hemorrhagic--Grey Turner's sign and Cullen's sign
Cullen's Sign Correct Ans-Umbilical discoloration, commonly seen in acute pancreatitis
Grey Turner's Sign Correct Ans-Flank discoloration, commonly seen in acute pancreatitis
Labs and Diagnostics of Acute Pancreatitis Correct Ans-WBC elevation: degree depends
upon severity
Hyperglycemia
Serum LDH and AST elevation
**Serum amylase (50-180) and lipase (14-280) elevated in 90% of cases
BUN and coags may be elevated
,Hypocalcemia, levels <7 may be associated with tetany; watch for Chvostek's sign and/or
Trousseau's sign
Elevated C-reactive protein suggests pancreatic necrosis
CT scan MORE useful than US
Ranson's Criteria
George
Washington
Got
Lazy
After
He
Broke
C-A-B-E Correct Ans-Used to evaluate prognosis (5-6 risk factors= 40% mortality; >7 risk
factors= approximately 100% mortality)
Signs at Admission:
1. Greater than 55 YO
2. WBCs >16,000
3. Glucose > 200
4. LDH >350
5. AST> 250
Signs during the 1st 48 hours:
1. Hct drop of >10
, 2. BUN increases >5
3. Calcium <8
4. Arterial O2 <60
5. Base deficit >4
6. Estimated fluid sequestration>6,000 mL
Management of Acute Pancreatitis Correct Ans-Ranson's Criteria
Bedrest
NPO
Aggresive IVF volume repletion
NG suction
Pain control
Once patient is pain free and has bowel sounds, may begin clear liquid diet
Bowel obstruction Correct Ans-Blockage of the lumen of the intestine that impedes passage
of gas and contents through the bowel
Major causes of Bowel Obstruction Correct Ans-1. Adhesion--look @ surgical hx for scar
tissues
2. Hernia
3. Volvulus
4. Tumors
5. Fecal Impaction--can lead to perforation
