Case 3 - pancreatitis Flashcards
what is acute pancreatitis
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
what are the main causes of acute pancreatitis
alcohol ingestion and acute intoxication
Gallstones - obstruct the pancreatic duct
Bile reflux
Trama
what is the clinical presentation of acute pancreatitis
severe abdominal pain that radiates to the back
Nausea and vomiting
Rapid development of shock
Greatly elevated serum amylase
what are the main causes of chronic pancreatitis
alcohol
Autoimmune pancreatitis
Cystic fibrosis
Hyperlipidemia
Idiopathic
what is the clinical presentation of chronic pancreatitis
Intermittent severe upper abdominal and back pain
Weight loss
Exocrine tissue replaced by fibrosis
Leads to pancreatic malabsorption
Relative preservation of endocrine tissue
what is the faecal elastase test
this is a stable proteolytic enzyme that can be picked up in the faeces. it indicates severe pancreatitis
what other tests are performed for diagnosis of chronic pancreatitis
CT/MRI and endoscopic ultrasound
what are the possible tests for CP
urine collection and test for PABA
what is the historical test for chronic pancreatitis
faecal fat analysis after a three day sample
what are the risk factors for chronic pancreatitis
tobacco smoke
Alcohol
Diabetes - independent predictor of mortality. It is difficult to manage as there is a risk of hypoglycaemia
how does alcohol affect secretions
it causes an individual to produce more viscous secretions
what does alcohol do to protein secretions
causes the pancreas to secrete more proteins secretions from the acinar cells
what does alcohol do to bicarbonate and water
reduces the secretion of bicarbonate ions and water from duct cells
what does this cause
prevents the enzymes from being carried away as part of pancreatic juice
what happens to these enzymes that cannot be carried away
these enzymes accumulate in the acini and begin to digest the pancreas itself
what do tobacco smoke and alcohol effect
the oxidative pathways in the body
what level of enzyme falls before the others and what does this cause
lipase levels fall before protease and amylase, causing fat malabsorption and steatorrhoea
what does malabsoprtion cause
weight loss
what does reduced bicarbonate in the intestine lead to
an acidic environment. this causes reduced bile acid secretion
what is the thing given as a replacement for pancreatic enzymes
Creon
what is pancreatin
a mixture of several digestive enzymes produced by the exocrine cells of the pancreas
what is pancreatin composed of
amylase, lipase and protease (trypsin)
features of pseudocysts - a chronic pancreatitis complication
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.
how can these pseudocysts be treated
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.
what is done for chronic pancreatitis patients for their risk of developing cancer
a CT is carried out every 3 years to pick up early changes in chronic pancreatitis patients of a developing cancer
what is oral rehydration therapy
provies an excellent demonstration of applied phstsiology
what is the name for a toxin in the intestine
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
how does oral rehydration work
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.
what is glutathione
stores in liver are used up in paracetamol and alcohol abuse
