Case 3 - pancreatitis

Question 1

what is acute pancreatitis

Answer 1

is an inflammatory condition that may cause extensive local damage to the pancreas, as well as comprise the function of other organs such as the lungs

Question 2

what are the main causes of acute pancreatitis

Answer 2

alcohol ingestion and acute intoxication
Gallstones - obstruct the pancreatic duct
Bile reflux
Trama

Question 3

what is the clinical presentation of acute pancreatitis

Answer 3

severe abdominal pain that radiates to the back
Nausea and vomiting
Rapid development of shock
Greatly elevated serum amylase

Question 4

what are the main causes of chronic pancreatitis

Answer 4

alcohol
Autoimmune pancreatitis
Cystic fibrosis
Hyperlipidemia
Idiopathic

Question 5

what is the clinical presentation of chronic pancreatitis

Answer 5

Intermittent severe upper abdominal and back pain
Weight loss
Exocrine tissue replaced by fibrosis
Leads to pancreatic malabsorption
Relative preservation of endocrine tissue

Question 6

what is the faecal elastase test

Answer 6

this is a stable proteolytic enzyme that can be picked up in the faeces. it indicates severe pancreatitis

Question 7

what other tests are performed for diagnosis of chronic pancreatitis

Answer 7

CT/MRI and endoscopic ultrasound

Question 8

what are the possible tests for CP

Answer 8

urine collection and test for PABA

Question 9

what is the historical test for chronic pancreatitis

Answer 9

faecal fat analysis after a three day sample

Question 10

what are the risk factors for chronic pancreatitis

Answer 10

tobacco smoke
Alcohol
Diabetes - independent predictor of mortality. It is difficult to manage as there is a risk of hypoglycaemia

Question 11

how does alcohol affect secretions

Answer 11

it causes an individual to produce more viscous secretions

Question 12

what does alcohol do to protein secretions

Answer 12

causes the pancreas to secrete more proteins secretions from the acinar cells

Question 13

what does alcohol do to bicarbonate and water

Answer 13

reduces the secretion of bicarbonate ions and water from duct cells

Question 14

what does this cause

Answer 14

prevents the enzymes from being carried away as part of pancreatic juice

Question 15

what happens to these enzymes that cannot be carried away

Answer 15

these enzymes accumulate in the acini and begin to digest the pancreas itself

Question 16

what do tobacco smoke and alcohol effect

Answer 16

the oxidative pathways in the body

Question 17

what level of enzyme falls before the others and what does this cause

Answer 17

lipase levels fall before protease and amylase, causing fat malabsorption and steatorrhoea

Question 18

what does malabsoprtion cause

Answer 18

weight loss

Question 19

what does reduced bicarbonate in the intestine lead to

Answer 19

an acidic environment. this causes reduced bile acid secretion

Question 20

what is the thing given as a replacement for pancreatic enzymes

Answer 20

Creon

Question 21

what is pancreatin

Answer 21

a mixture of several digestive enzymes produced by the exocrine cells of the pancreas

Question 22

what is pancreatin composed of

Answer 22

amylase, lipase and protease (trypsin)

Question 23

features of pseudocysts - a chronic pancreatitis complication

Answer 23

Localised fluid collection – this is as a response to chronic inflammation usually.
Can be massive - obstruction and can cause pressure on the surrounding tissue and cause pain.
Can become infected
To treat pseudocysts, the fluid can be drained:
FNA fluid analysis : Amylase and Ca 19-9 will show if the pseudocyst is pancreatic.

Question 24

how can these pseudocysts be treated

Answer 24

There are new stents that can now be placed inside the cyst itself, which not only draws out the fluid, but provides access to the tissue inside the cyst. These stents have decreasaed the rates of surgery because of their success.

Question 25

what is done for chronic pancreatitis patients for their risk of developing cancer

Answer 25

a CT is carried out every 3 years to pick up early changes in chronic pancreatitis patients of a developing cancer

Question 26

what is oral rehydration therapy

Answer 26

provies an excellent demonstration of applied phstsiology

Question 27

what is the name for a toxin in the intestine

Answer 27

many dirrheal illnesses are caused by bacterial exotoxins that induce fluid and electrolyte secretion by the intestine, therefore a toxin is referred to as an enterotoxin

Question 28

how does oral rehydration work

Answer 28

Despite the massive toxin-induced fluid secretion, both intestinal morphology and nutrient coupled Na+ absorption are normal.

Because nutrient-coupled (e.g., glucose or amino acid) fluid absorption is intact, therapeutically increasing the concentration of glucose or amino acids in the intestinal lumen can enhance absorption.

ORS contains varying concentrations of glucose, Na+, Cl−, and HCO3 and is extremely effective in enhancing fluid and electrolyte absorption in secretory diarrhoea when the intestine secretes massive amounts of fluid.

Administration of ORS can reverse the dehydration and metabolic acidosis that may occur in severe diarrhoea and that are often the primary cause of morbidity and mortality, especially in children younger than 5 years.

Question 29

what is glutathione

Answer 29

stores in liver are used up in paracetamol and alcohol abuse