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GI Exam 2 > Chronic Pancreatitis > Flashcards

Chronic Pancreatitis Flashcards

1
Q

Progressive fibro-inflammatory disease

A

Chronic pancreatitis

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2
Q

What is the triad for chronic pancreatitis?

A
  1. Acinar loss
  2. Mononuclear cell infiltration
  3. Fibrosis
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3
Q

What are 3 factors that contribute to causing chronic pancreatitis?

A
  1. Complications of an acute flare
  2. Coexisting disease
  3. Effects of alcohol abuse
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4
Q

How much of the pancreas needs to be damaged before May digestion of fat and protein is identified?

A

Over 90%

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5
Q

A high incidence of ______ and _______ present initially in chronic pancreatitis

A

Hypoglycemia; hyperglycemia

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6
Q

What is the leading cause of chronic pancreatitis?

A

Alcohol

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7
Q

When does alcoholic pancreatitis present?

A

In the 4th or 5th decade of life

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8
Q

What is a sign of alcoholic pancreatitis?

A

Steatorrhea

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9
Q

What are the 5 causes of chronic pancreatitis?

A
  1. Alcoholic
  2. Autoimmune
  3. Genetic
  4. Toxic causes
  5. Idiopathic
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10
Q

What cells do ethanol metabolites injure?

A

Acinar cells

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11
Q

What might stimulate autoimmune pancreatitis?

A

H. Pylori infection or other inflammatory factors

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12
Q

True or false: autoimmune pancreatitis presents typically in women

A

False

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13
Q

What is a rare deficiency that can cause genetic pancreatitis?

A

SPINK1 function

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14
Q

What may be deficient that can cause genetic pancreatitis?

A

CFTR (cystic fibrosis)

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15
Q

What patient population is affected by tropical pancreatitis?

A

Youth

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16
Q

What is tropical pancreatitis caused by?

A

Cassava root

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17
Q

What are 2 direct toxicities to Acinar cells that can lead to fibrosis?

A
  1. Cigarette smoking
  2. Kerosene
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18
Q

What is the first clinical symptom seen with chronic pancreatitis?

A

Pain

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19
Q

What are 2 symptoms that are signs of local complications?

A
  1. Jaundice
  2. Radiating pain
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20
Q

What are 3 symptoms that can lead to the diagnosis of chronic pancreatitis?

A
  1. Pain
  2. Fatty stools
  3. Diabetes
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21
Q

What are 4 disease states that can give clues towards a diagnosis of chronic pancreatitis?

A
  1. Diabetes
  2. Hyperlipidemia
  3. Hypercalcemia
  4. Abnormal liver function tests
22
Q

A stepwise approach for diagnosis for chronic pancreatitis is not necessary if what 2 things are present?

A
  1. Fatty stool
  2. Long history of pancreatitis attacks or pain
23
Q

How long does episodic pain last?

A

Approx. 1 week

24
Q

Episodic pain is generally _______ and radiates where?

A

Epigastric; to the back

25
Q

How would you describe the chronic pain?

A

Continuous or waxing and waning

26
Q

What is 1st line treatment for episodic pain?

A

Acetaminophen or NSAIDs PRN

27
Q

What is second line treatment for episodic pain?

A

Tramadol

28
Q

What is first line treatment for chronic pain?

A

Tramadol

29
Q

What is third line treatment for episodic pain?

A

Neuroleptic antidepressants
1. Pregabilin
2. TCAs
3. SSRIs

30
Q

What is the MOA of Tramadol?

A

Mu-receptor agonist

31
Q

What are 4 ADRs of Tramadol?

A
  1. Dizziness
  2. Constipation
  3. Peripheral edema
  4. Seizures
32
Q

What does lyrica inhibit?

A

Central sensitization

33
Q

What are 3 ADRs of pregabalin?

A
  1. Peripheral edema
  2. CNS toxicity
  3. Weight gain
34
Q

Is stool consistency is corrected, what is reduced?

A

Pain

35
Q

What 4 things should be utilized to prevent flares?

A
  1. Avoid alcohol
  2. Smoking cessation
  3. Manage hypertriglyceridemia
  4. Avoidance of foods that trigger flares
36
Q

What are 5 signs of malabsorption?

A
  1. Diarrhea
  2. Steatorrhea
  3. Weight loss
  4. Metabolic bone disease
  5. Vitamin and mineral deficiency
37
Q

What is the hallmark symptom for diagnosis?

A

Steatorrhea

38
Q

How long should you conduct an analysis of fecal fat concentration while on a high fat diet?

A

72 hours

39
Q

All of the pancreatic enzymes are sensitive to degradation by acid, what is used to combat this?

A

Enteric coating

40
Q

What is the initial therapy for the pancreatic enzymes?

A

30,000 to 50,000 IU per meal

41
Q

What is the dose for the pancreatic enzymes if the patient is eating snacks?

A

1/2 dose

42
Q

How would you manage the failure to respond to pancreatic enzymes?

A
  1. Low fat diet
  2. Increase dose
  3. Optimize acid lowering therapy
43
Q

What pancreatic enzyme is the DOC if the patient had proof gastric surgery or hypochlorhydria?

A

Viokace

44
Q

True or false: The pancreatic enzymes cannot be substituted

A

True

45
Q

How are the pancreatic enzymes taken?

A

With meals

46
Q

What must viokace be administered with?

A

PPI

47
Q

Some pancreatic enzyme capsules can be opened and put into what food?

A

Applesauce

48
Q

What are the most difficult patients to manage in chronic pancreatitis?

A

Diabetes patients

49
Q

What is the main goal for diabetes in the case of chronic pancreatitis?

A

Prevent hypoglycemia

50
Q

What is the glucose goal for pancreatitis patients?

A

140-180

GI Exam 2 (11 decks)

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