chronic pancreatitis

Question 1

steatorrhea and diabetes in chronic pancreatitis

Answer 1

The fecal fat in these late-stage patients is higher
than with other disorders-it may be > 100 gm/day. > 40 gm/day is highly suggestive of chronic pancreatitis. 1/3 of patients with chronic pancreatitis develop diabetes

Question 2

The classic diagnostic triad for chronic pancreatitis is:

Answer 2

• pancreatic calcification
• diabetes
• steatorrhea

Question 3

what to do first in the evaluation of chronic pancreatitis?

Answer 3

First. get a flat-plate x-ray of the abdomen and a serum trypsin level-if the pancreas is calcified,or if the serum trypsin is abnormally low, you have made the diagnosis of chronic pancreatitis!

Question 4

2nd level tests used in the diagnosis of chronic pancreatitis, if needed, are

Answer 4

• abdominal U/S
• abdominal CT
• endoscopic ultrasound-very sensitive and increasingly utilized
• secretin stimulation test

Question 5

If results after 1st and 2nd evaluations are still negative, and you still have suspicions for chronic pancreatitis

Answer 5

do either ERCP or magnetic resonance cholangiopancrcatography (MRCP)

Question 6

The secretin test in diagnosis of chronic pancreatitis

Answer 6

The secretin test is the most sensitive test for pancreatic function but it is complicated, so it is usually performed only in major medical centers, and only when there is still a high “index of suspicion” after a negative ERCP

Question 7

A major complication is persistent and severe abdominal pain. In this setting,what to do?

Answer 7

1) rule out continued ETOH use
2) rule out pseudocyst
3) do an ERCP, MRCP, or EUS to define duct anatomy
4) try high-dose pancreatic enzymes to shut off the entero-pancreatic (intestine-pancreas) axis

Question 8

DM in chronic pancreatitis patients

Answer 8

There is a decrease in production of insulin and glucagon. Because the pancreas is producing so little glucagon. the patient is very prone to hypoglycemia. Therefore, loose control of the hyperglycemia is recommended-to decrease the chance of a hypoglycemic episode. These patients do not have the retinopathy and nephropathy associated with the usual DM. They commonly have neuropathy, but it is more likely caused by alcoholism and/or malnutrition.

Question 9

treatment of chronic pancreatitis

Answer 9

Treatment includes pancreatic enzymes (20,000-30,000 units of lipase/day), decreasing dietary fat, and adding medium chain triglycerides to the diet. Pancreatic enzymes must either have an enteric coating or be given with antacids/H2 blockers because gastric acid destroys enzymes