GASTROENTEROLOGY ARTICLE OF THE WEEK
September 20, 2007
Pandol SJ, Saluja AK, Imrie CW, Banks PA. Acute pancreatitis: Bench to the bedside. Gastroenterology 2007:132;1127-1151.
1. Potential pathogenetic mechanisms for gallstone pancreatitis include
a. reflux of bile into the pancreatic duct leading to increase in intracellular calcium in the pancreatic acinar cells
b. obstruction of the pancreatic duct without bile reflux
c. Formation of fatty acid esters in the acinar cells
d. Activation of zymogens by direct effect of bile salt on amylase and lipase
2. Initial care of the patient of the patient with acute pancreatitis include
a. aggressive fluid resuscitation
b. supplemental oxygen and monitoring for hypoxemia
c. arterial blood gas determination is needed only if oxygen saturation is <95% in room air
d. transfer to the ICU if evidence of renal impairment
3. The most important determinant of survival in acute pancreatitis is
a. degree of amylase elevation
b. extent of pancreatic necrosis on CT scan
c. organ failure of any duration
d. organ failure that lasts over 48 hours
True or False
4. Necrotizing pancreatitis associated with no evidence of organ failure has a mortality of 15 to 20%
5. Ligation of the pancreatic duct in laboratory animals usually results in acute pancreatitis
6. The presence of intra and extrapancreatic vasospasm detected by angiopgraphy early in the course of pancreatitis predicts progression to severe necrotizing pancreatitis
7. The severity of acute pancreatitis is determined by the magnitude of the initial acinar injury
8. Mitochondrial damage with depletion of ATP is more likely to lead to necrosis rather than apoptosis as the mechanism of cell death.
9. Fever occurring on day 3 of hospitalization in a patient with necrotizing pancreatitis requires needle aspiration of the pancreas to detect infected necrosis
10. Pentamidine-induced pancreatitis usually develops within the first week of treatment
11. Pancreatic elastase, but not amylase or lipase cause lung injury leading to ARDS
12. Apoptosis is the mechanism for pancreatic cell death that results in marked inflammation
13. Zymogen activation occurs as a result of pancreatitis and is not the cause of pancreatitis
14. The heat shock proteins play an important role in protecting the pancreas after injury
15. Acute pancreatitis may be the initial presenting symptom of pancreatic cancer
16. Prophylactic antibiotics should not be used in patients with pancreatic necrosis to prevent infection