Chronic Pancreatitis – Flashcards
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What is the most common etiology of chronic pancreatitis?
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alcohol
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Alcoholic pancreatitis A. Alcohol (decreases or increases?) viscosity of pancreatic secretions resulting in plugs of ________ B. _________ levels of alcohol needed in women (lower or higher?) C. ETOH may cause spasm of what? D. ETOH causes loss of _______ which keeps pancreatic juices in solution E. By the time you have pancreatitis from ETOH, you already have what?
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A. Alcohol increases viscosity of pancreatic secretions resulting in plugs of protein (lithostathine) B. Lower C. Sphincter of Oddi spasm D. R protein E. chronic pancreatitis
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Does Gallstone pancreatitis cause chronic disease?
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No. (it causes acute pancreatitis)
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What complications are associated with chronic pnacreatitis?
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•Pain •Diabetes •Pseudocysts •duodenal or bile duct obstruction •pancreatic cancer (elevated CA 19-9) •Steatorrhea, weight loss •Splenic vein thrombosis; gastric varices
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What is the tumor marker that is elevated in pancreatic cancer?
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CA 19-9
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Which clinical feature is seen in alcoholic chronic pancreatitis more commonly than idiopathic chronic pancreatitis?
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Calcification (pain, steatorrhea and diabetes are pretty even between alcoholic and idiopathic)
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In chronic pancreatitis, what does the lipase output have to be before they get staetorrhea?
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•When 90% of their lipase is gone they get steatorrhea!! •When lipase output is below 10%
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Which complication of chronic pancreatitis? •Loss of insulin and glucagon •Only in severe disease •Brittle •Insulin requirement low •Ketoacidosis rare
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Diabetes
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Chronic Pancreatitis defined Structurally: 1. Which technique may show calcific pancreatitis, dilated CBD or PD 2. Which techniques are most useful to assess structure; e.g. pancreatic cancer, pancreatic duct stone, pancreatic duct stricture, pseudocyst.
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1. CT 2. MRCP & ERCP
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Which diagnostic technique has the risk of inducing pancreatitis?
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ERCP
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Chronic Pancreatitis As Defined Functionally 1. What two "special" tests can be used? 2. Which test is used to look for Steatorrhea (90% of lipase must be gone) 3. Which test involves giving enteric-coated enzymes and see if steatorrhea resolves
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1. Secretin Stimulation test and Bentiromide Test 2. Fecal fats (Sudan Fat Stain) 3. Pancreatic enzyme challenge
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Which test for chronic pancreatitis? •Substance given IV causes stimulation of the pancreas; they look at the volume that you put out from the pancreas and the bicarbonate levels •Bicarbonate and Volume should both increase by so much or else you have pancreatitis •Sensitive and specific •Unpleasant •Time consuming •Requires x-rays •Not readily available
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Secretin Test
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Which test for chronic pancreatitis? •If they are functioning in regards to the pancreas you should get half of the PABA back in the urine •Easy •Available •Low sensitivity •High specificity
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Bentiromide Test
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Steatorrhea A. Excessive fats in stool B. Sudan fat stain tests for split fats or neutral (whole fats) C. Small bowel mucosal disease causes excessive _____ fats (celiac sprue, lymphangectasia, Whipple's dx., Crohn's disease, amyloidosis) D. Chronic pancreatitis causes excessive _______ fats E. _______ test tests for mucosal integrity F. Biopsy and x-rays of small bowel test for mucosal diseases
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C. Small bowel mucosal disease causes excessive split fats (celiac sprue, lymphangectasia, Whipple's dx., Crohn's disease, amyloidosis) D. Chronic pancreatitis causes excessive neutral fats E. D-xylose test tests for mucosal integrity (Pt. ingests D-xylose and 50% must be recovered in urine)
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Which pancreatic enzymes are used to treat pancreatic pain by being available in the duodenum? Given with antacids to increase bioavailability. High in peptidases.
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Non-enteric coated pancreatic enzymes
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Which pancreatic enzymes are used to treat steatorrhea to decrease diarrhea and malabsorption. High in lipase and able to withstand acid
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Enteric- coated pancreatic enzymes
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Non-enteric coated pancreatic enzymes are used to treat what part of chronic pancreatitis?
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pain
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Enteric coated pancreatic enzymes are used to treat what part of chronic pancreatitis?
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steatorrhea
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What causes a pseudocyst?
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↑ Intraductal pressure
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Treatment of a pseudocyst
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Internal drainage
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•Causes Inflammation/fibrosis Pseudocyst •Symptoms Vomiting Pain Which complication of chronic pancreatitis? Tx?
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Duodenal Obstruction •Treatment Gastrojejunostomy Whipple Pseudocyst drainage
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•Causes Inflammation/fibrosis Pseudocyst •Symptoms Pruritus Pain •Complications Sepsis Biliary cirrhosis Which complication of chronic pancreatitis? Tx?
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Common Bile Duct Obstruction •Treatment Decompression Bypass
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•Causes Ruptured duct Leaking pseudocyst •Symptoms Abdominal distension Cachexia Pain variable •Diagnosis Paracentesis (high amylase) Which complication of chronic pancreatitis? Tx?
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Pancreatic Ascites •Treatment Medical: TPN Surgical: After ERCP
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•Causes Ruptured duct Leaking pseudocyst •Symptom Dyspnea •Diagnosis Thoracentesis (high amylase) Which complication of chronic pancreatitis? Tx?
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Pleural Effusion •Treatment Chest tube not definitive Surgical- After ERCP
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•Childhood onset common •Initially acute attacks •Calcification common by 2nd decade •Increased incidence of carcinoma Which type of pancreatitis?
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Hereditary Pancreatitis
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What is the inheritence pattern of hereditary pancreatitis?
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Autosomal dominant, variable penetrance
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Most common cause of chronic pancreatitis?
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Alcohol is most common cause
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Calcification in chronic pancreatitis is due to what?
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loss of R protein
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Tx for chronic pancretitis: 1. enteric coated enzymes for which symptom? 2. non-coated enzymes for which symptom?
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1. enteric coated enzymes for diarrhea 2. non-coated enzymes for pain
