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GI > Chronic Pancreatitis > Flashcards

Chronic Pancreatitis Flashcards

1
Q

What is the triad of chronic hepatitis?

A
  1. acinar loss
  2. mononuclear cell infiltration
  3. fibrosis
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2
Q

How much of the pancreas must be damaged before mal-digestion of fat and protein is identified?

A

90%

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3
Q

What can pancreatitis initially present as?

A

high incidence of hyper and hypo glycemia

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4
Q

What are the causes of chronic pancreatitis?

A
  1. alcoholic
  2. autoimmune
  3. toxic causes
  4. genetic
  5. idiopathic
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5
Q

What is autoimmune pancreatitis usually stimulated by?

A

H. pylori

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6
Q

What genetic mutations are correlated with chronic pancreatitis?

A

SPINK 1 function
CFTR deficiency

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7
Q

What causes tropical pancreatitis?

A

cyanogenic glycosides in cassava

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8
Q

What toxicities cause chronic pancreatitis?

A

inhaled hydrocarbons:
1. cigarette smoke
2. kerosene

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9
Q

What are clinical features with chronic features?

A
  1. pain
  2. fatty stools
  3. diabetes
  4. malnutrition
    (2-3 can be interchanged)
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10
Q

What are the presentations of chronic pancreatitis?

A
  1. recurrent acute pancreatitis
  2. Constant/radiating pain
  3. jaundice
  4. steatorrhea
  5. diabetes
  6. fatty stools
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11
Q

What laboratory tests are related to chronic pancreatitis?

A
  1. diabetes
  2. hyperlipidemia
  3. hypercalcemia
  4. abnormal LFTs
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12
Q

When is a stepwise approach to chronic pancreatitis dose not needed?

A

presentation of fatty stool
AND
long history of pancreatitis attacks or pain

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13
Q

What is the first line treatment for pain related to chronic pancreatitis according to WHO guidelines?

A

Acetaminophen or NSAIDs prn

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14
Q

What is the second-line treatment (chronic first-line therapy) for pain related to chronic pancreatitis according to WHO guidelines?

A

Tramadol

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15
Q

What is the third-line treatment for pain related to chronic pancreatitis according to WHO guidelines?

A

Pregabalin
TCAs
SSRIs

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16
Q

What agents should be avoided in chronic pancreatitis for pain?

A

narcotics

17
Q

What is the DOC for chronic pain control?

A

Tramadol

18
Q

What is the MOA of trmamdol?

A

mu-receptor agonist

19
Q

What are SEs with Tramadol?

A

dizziness
constipation
peripheral edema
seizures

20
Q

A decrease in _______ _______ increases likely hood of seizures

A

renal clearance

21
Q

Which agent is FDA-approved for pain with chronic pancreatitis?

A

Pregabalin

22
Q

What are SEs with Pregabalin?

A

peripheral edema
CNS toxicity
weight gain

23
Q

What is an alternative treatment to manage pain with chronic pancreatitis?

A

pancreatic enzymes correct stool consistency, reducing pain

24
Q

How are flares prevented?

A

avoid alcohol
smoking cessation
manage hypertriglyceridemia
avoid trigger foods

25
Q

What are signs of malabsorption?

A
  1. diarrhea
  2. steatorrhea
  3. weight loss
  4. metabolic bone disease
  5. vitamin / mineral deficency
26
Q

What is required for diagnosis of steatorrhea?

A

72-hour analysis of fecal fat concentration while on a high-fat diet
OR
clinical symptoms of steatorrhea
AND
low levels of fecal elastase

27
Q

How are pancreatic enzyme therapy formulated to prevent degradation by acid in the stomach?

A

enteric coating

28
Q

What is the dose of pancreatic enzymes taken with every meal?

A

30,000-50,000 IU

29
Q

What is the dose of pancreatic enzymes taken with snacks?

A

1/2 dose taken with meals

30
Q

How is failure to respond to pancreatic enzymes monitored?

A

diarrhea
weight gain
increase in ADEK (fat soluble) vitamin levels

31
Q

What is the pancreatic enzyme drug of choice if prior gastric surgery or hypochlorhydria? Why?

A

Viokace (non-enteric coated)

32
Q

Are pancreatic enzyme products interchangeable?

A

no, not A/B rated

33
Q

What are all pancreatic enzyme therapies derived from?

A

porcine, pig

34
Q

What must Viokace be administered with since it is not enteric coated?

A

PPI

35
Q

How should pancreatic enzyme therapy be taken?

A

WITH meals, spread out dose if eating a long meal

36
Q

Can pancreatic enzyme therapy be crushed or chewed?

A

no only some products can be opened and put in applesauce (Pancreaze)

37
Q

What is recommended to manage diabetes with chronic pancreatitis?

A

simple insulin regimens

GI (23 decks)

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