GASTROENTEROLOGY LITERATURE REVIEW SESSION
October 21, 1999
Baron TH, Morgan DE. Acute Necrotizing Pancreatitis. N Engl J Med 1999;340:1412-1417. |
1. Surgery for severe pancreatitis
a. should be undertaken soon after necrotizing pancreatitis is diagnosed
b. does not improve mortality in patients with severe interstitial pancreatitis
c. should be undertaken in patients with infected pancreatic necrosis, only after a 7 day trial of antibiotics has been ineffective in controlling fever
d. in infected pancreatic necrosis, surgery should be done as soon as possible after diagnosis of infection
2. The antibiotic of choice to treat or prevent pancreatic necrosis is
a. ampicillin and gentamycin
b. ceftriaxone
c. imipenen-cilastatin
d. ciprofloxacin
e. metronidazole
3. Diagnosis of pancreatic necrosis
a. can be made by ultrasound examination
b. is best made by non-contrasted CT scan exam
c. becomes evident on CT scan examination within hours after admission
d. is best detected several days after initial clinical presentation by performing a dynamic intravenous contrast-enhanced CT scan
4. Mortality in severe pancreatitis
a. overall is 30%
b. early deaths are defined as deaths within the first 3-4 days of admission
c. early deaths are usually due to multisystem organ failure secondary to release of inflammatory mediators and cytokines
d. late deaths are due to septic complications
e. sterile necrotic pancreatitis has the same prognosis as infected necrotic pancreatitis
5. Infected necrosis
a. the incidence is not related to the amount of necrosis in the pancreas
b. infection typically arises within the first week of admission
c. develops in 30% to 70% of patients with acute necrotizing pancreatitis
d. accounts for >80% of deaths from acute pancreatitis
e. the risk peaks at 3 weeks after clinical presentation
True or False
6. ERCP in patients with severe necrotizing pancreatitis may increase the risk of infected necrosis
7. Early intervention with ERCP and papillotomy results in improved outcome in most patients admitted with biliary pancreatitis
8. Infection of the necrotic pancreatic tissue results from migration of small bowel bacterial through the pancreatic duct.
9. Systemic antibiotics decrease mortality in patients with severe interstitial pancreatitis as well as those with severe pancreatic necrosis
10. In patients who recover from severe gallstone necrotizing pancreatitis, ERCP studies years later usually show return to a normal pancreatic anatomy.
11. The early use of TPN in patients with severe pancreatitis hastens the resolution of acute pancreatitis.
12. Improvement in the outcome of severe gallstone pancreatitis treated with early ERCP and sphincterotomy occur because the severity of pancreatitis is decreased.
13. In the absence of ileus, feeding via a jejunal tube placed beyond the ligament of Treitz is preferable to TPN in cases of severe pancreatitis.
14. Regarding antibiotic therapy for acute necrotizing pancreatitis
a. must be given intravenously, oral and rectal therapy is never effective
b. therapy should be started only after infected pancreatic necrosis has been confirmed by needle aspiration
c. therapy should be started as soon as interstitial pancreatitis is diagnosed
d. therapy should last 1 to 2 weeks
e. therapy should start as soon as necrotizing pancreatitis is diagnosed
f. therapy should start on patients with acute pancreatitis, fever and leukocytosis
15. Criteria for the diagnosis of severe pancreatitis include
a. severity of abdominal pain
b. >3 Ranson's criteria
c. APACHE II score of >8
d. magnitude of lipase elevation
e. presence of shock, renal insufficiency, or pulmonary insufficiency