Pancreatitis & Celiac Disease Flashcards
What are the 2 key concepts in acute pancreatitis tx?
requires early and aggressive intravenous fluid resuscitation
Managed similarly to pts with sepsis
What sx are present in an inflammatory episode of acute pancreatitis?
intrapancreatic enzyme activation with pain
nausea and vomiting
intestinal ileus
What are the 5 causes of Acute Pancreatitis?
Alcohol
Gallstones (including microlithiasis)
Trauma/surgery
Acute discontinuation of medications for diabetes or hyperlipidemia
Following endoscopic retrograde cholangiopancreatography (ERCP)
What meds can cause acute pancreatitis?
ACE, ARBS; thiazide diuretics, furosemide
Antimetabolites (mercaptopurine and azathioprine)
Corticosteroids; glyburide; exenatide (Byetta)
Mesalamine; pentamidine
Sulfamethoxazole/trimethoprim
Valproic acid
HMG-CoA reductase inhibitors, especially simvastatin
What are 4 possible mechanisms of drug-induced acute pancreatitis?
direct toxic effects of the drug or its metabolites
hypersensitivity
drug-induced hypertriglyceridemia
alterations of cellular function in the pancreas and pancreatic duct
What is the 1st line tx for acute pancreatitis?
Fluid resuscitation: isotonic crystalloid solution— NS or LR
Why is fluid resuscitation given in acute pancreatitis?
to reduce the risks of SIRS and organ failure
What should you do if vomiting persists past fluid resuscitation in acute pancreatitis?
NPO or NG tube
Fluid resuscitation can be ____________ or _________.
Fluid resuscitation can be e__nteral or parenteral.
Begin oral alimentation after pain, tenderness, and ileus have resolved: small amounts of high-carbohydrate, low-fat, and low-protein foods; advance as tolerated
What type of pancreatitis is this tx used for?
Acute Pancreatitis
What should you advise pts with acute pancreatitis during discharge?
dietary modification to reduce dietary fats, alcohol, and added sugars
Long-standing and progressive destruction of pancreatic tissue due to persistent inflammation
Results in exocrine and/or endocrine insufficiency
Which type of pancreatitis?
Chronic Pancreatitis
What are the hallmark complications of Chronic Pancreatitis?
chronic pain
malabsorption with resultant steatorrhea
diabetes mellitus
risk of pancreatic cancer
What are the primary treatments for malabsorption due to chronic pancreatitis?
pancreatic enzyme supplementation
reduction in dietary fat intake
Which drug can cause an increase in sphincter of Oddi pressure?
Morphine
Why should you avoid Demerol in tx of acute pancreatitis?
porential of accumulation of a toxic metabolite normeperidine
What tx is no longer recommended for acute pancreatitis?
prophylactic abx
How do you tx pts with ascending cholangitis or necrotizing pancreatitis?
B-lactam/B-lactamase inhibitor: piperacillin/tazobactam can be considered for initial treatment before cultures (especially of aspirated collections) if a strong suspicion of active infection.
What do you tx acute pancreatitis with if pt has cholangitis and pt is allergic to penicillin?
Levofloxacin
What should you be vigilant for when giving prophylactic abx in acute pancreatitis?
fungal superinfections
What are the tx options for chronic pancreatitis?
enteric-coated pancreatic enzyme supplements
antisecretory agent + pancreatic enzyme supplementation
What can you add to enteric-coated pancreatic enzyme supplements to increase the effectiveness of enzyme therapy for malabsorption and steatorrhea found in chronic pancreatitis?
Histamine2-receptor antagonist or proton-pump inhibitor
What would adding an antisecretory agent to pancreatic enzyme supplementation help achieve?
may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea
What are possible chronic pancreatitis txs?
Analgesics: tramadol, chronic opioid, gabapentin, pregabalin, SNRIs or TCAs, traditional pancreatic enzyme supplements
Uncoated enzymes (Viokase)
Octreotide
Uncoated enzymes (Viokase) may be more efficacious for what sx when given with what other medication?
Uncoated enzymes (Viokase) may be more efficacious for pain control (when given with proton pump inhibitors [PPIs] to protect their integrity) compared with coated enzymes, but this strategy is controversial.
T/F: There is a theoretical benefit to using PPIs, even with coated enzymes, in patients with vitamin deficiency to allow faster release of enzymes into the proximal duodenum where fat-soluble vitamin absorption occurs
True
When would you treat pts with corticosteroids?
autoimmune pancreatitis
When should you administer pancreatic enzymes?
during or just after meals
T/F: Products containing enteric-coated microspheres or minimicrospheres may be less effective than other dose forms
False; Products containing enteric-coated microspheres or minimicrospheres may be more effective than other dose forms
Primarily used to treat malabsorption associated with chronic pancreatitis
also used to treat pain from the disease
Which drug?
Pancreatic Enzymes
Relief of pain is thought to be due to their ability to break down CCK
Which drug?
Pancreatic Enzymes
T/F: the release of CCK, which causes an increase in pancreatic secretion, is not inhibited by trypsin
False; the release of CCK, which causes an increase in pancreatic secretion, is inhibited by trypsin
Which drugs cause a decrease in the production of trypsin in patients with chronic pancreatitis?
Pancreatic Enzymes
Proteases in pancreatic enzymes supplements act as what?
substitutes for endogenous trypsin, leading to a decrease in CCK release
Autoimmune condition: Immune-mediated reaction to dietary gluten: found in wheat, barley, rye
Affects small intestine
Genetically predisposed individuals–Homogenicity for HLA-DQ2/DQ8
Which disease is this?
Celiac Disease
Individuals with this disease have a sensitivity to gliadin fraction in glutens
Which disease?
Celiac Disease
What is the pathology of Celiac Disease?
Immunologic cross-reactivity, inflammation, and tissue damage (villous atrophy) with subsequent malabsorption
What does the mnemonic for Celiac Disease stand for?
C: Consultation with a skilled dietician
E: Education about the diease
L: lifelong adherence to a gluten-free diet
I: identifying and treating nutritional deficiencies
A: Access to an advocacy group
C: Continuous long-term follow-up bu a multidisciplinary team
Which 4 things are overlooked as sources of gluten?
- oral prescription drugs
- nonprescription drugs
- vitamin and mineral supplements
- health and beauty aids and cosmetics
What is the main tx for Celiac Disease?
remove gluten from the diet
What are safe and palatable substitutes for gluten?
Rice, corn, soybean flour
Grains: uncontaminated oats, rice, corn, tapioca, quinoa, amaranth, sorghum
What should the oat limit be if you have Celiac disease?
50-60g a day
Levels of _________ normalize with gluten abstinence
IgA antigliadin
What 5 medications would you use for refractory disease-case reports of Celiac disease?
Steroids
Azathioprine
Cyclosporine
Tacrolimus
Infliximab, alemtuzumab
Nutritional deficiencies of what require supplementation?
vitamins (A, D, E, B12)
calcium
carotene
copper
zinc
folic acid
ferritin
iron
T/F: Pneumococcal vaccination: celiac disease is associated with hyposplenism
True
