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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â¢Pain â¢Diabetes â¢Pseudocysts â¢duodenal or bile duct obstruction â¢pancreatic cancer (elevated CA 19-9) â¢Steatorrhea, weight loss â¢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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â¢When 90% of their lipase is gone they get steatorrhea!! â¢When lipase output is below 10%
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Which complication of chronic pancreatitis? â¢Loss of insulin and glucagon â¢Only in severe disease â¢Brittle â¢Insulin requirement low â¢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? â¢Substance given IV causes stimulation of the pancreas; they look at the volume that you put out from the pancreas and the bicarbonate levels â¢Bicarbonate and Volume should both increase by so much or else you have pancreatitis â¢Sensitive and specific â¢Unpleasant â¢Time consuming â¢Requires x-rays â¢Not readily available
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Secretin Test
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Which test for chronic pancreatitis? â¢If they are functioning in regards to the pancreas you should get half of the PABA back in the urine â¢Easy â¢Available â¢Low sensitivity â¢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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â Intraductal pressure
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Treatment of a pseudocyst
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Internal drainage
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â¢Causes Inflammation/fibrosis Pseudocyst â¢Symptoms Vomiting Pain Which complication of chronic pancreatitis? Tx?
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Duodenal Obstruction â¢Treatment Gastrojejunostomy Whipple Pseudocyst drainage
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â¢Causes Inflammation/fibrosis Pseudocyst â¢Symptoms Pruritus Pain â¢Complications Sepsis Biliary cirrhosis Which complication of chronic pancreatitis? Tx?
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Common Bile Duct Obstruction â¢Treatment Decompression Bypass
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â¢Causes Ruptured duct Leaking pseudocyst â¢Symptoms Abdominal distension Cachexia Pain variable â¢Diagnosis Paracentesis (high amylase) Which complication of chronic pancreatitis? Tx?
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Pancreatic Ascites â¢Treatment Medical: TPN Surgical: After ERCP
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â¢Causes Ruptured duct Leaking pseudocyst â¢Symptom Dyspnea â¢Diagnosis Thoracentesis (high amylase) Which complication of chronic pancreatitis? Tx?
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Pleural Effusion â¢Treatment Chest tube not definitive Surgical- After ERCP
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â¢Childhood onset common â¢Initially acute attacks â¢Calcification common by 2nd decade â¢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
