Resident Morning Report – 12/16

Teaching Pearls:

  • Common causes of pancreatitis:
    • gallstones, alcohol, hypertriglyceridemia, hypercalcemia, medications, infectious, trauma, scorpion bites, autoimmune, idiopathic, etc
  • Not recommended to trend lipases
    • Although on certain occasions, decrease in lipase may help suggest a certain etiology.
    • Fast decrease in lipase level can be associated with passed gallstone.
  • Normal CBD normal is <6mm. Can widen in non-pathologic conditions including age and post-cholecystectomy.
  • LFT Abnormalities
    • Hepatocellular – defined by severe elevation in AST and ALT in proportion to Alk phos
    • Cholestatic – defined by severe elevation in alkaline phosphatase compared to AST and ALT
    • Both can have elevated bilirubin levels
  • Causes of cholestatic jaundice includes:
    • Primary biliary cirrhosis, primary sclerosing cholangitis, large bile duct obstruction, infiltrative liver disease, malignancy (pancreatic carcinoma, ampullary carcinoma, cholangiocarcinoma), cholangitis, extrahepatic pancreatic mass, choledocholithiasis.
  • MRCP is good for detecting proximal bile duct lesions, but sensitivity worsens distally.
  • EUS has good sensitivity for distal bile duct lesions and obstructions.
  • Autoimmune Pancreatitis
    • Can manifest by a pancreatic mass that is often confused with pancreatic carcinoma.
    • Recurrent pancreatitis is common and occurs more frequently in focal disease.
    • May lead to pancreatic duct strictures.
    • Most common presentation is obstructive jaundice.
    • A pancreatic biopsy is usually required to establish the diagnosis.
    • Important to check IgG4 levels and CA 19-9.
      • Higher levels of IgG4 levels decreases sensitivity, but increases specificity of autoimmune pancreatitis.

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