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MJ- P2 E2 > Pancreatitis & Celiac Disease > Flashcards

Pancreatitis & Celiac Disease Flashcards

1
Q

What are the 2 key concepts in acute pancreatitis tx?

A

requires early and aggressive intravenous fluid resuscitation

Managed similarly to pts with sepsis

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2
Q

What sx are present in an inflammatory episode of acute pancreatitis?

A

intrapancreatic enzyme activation with pain

nausea and vomiting

intestinal ileus

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3
Q

What are the 5 causes of Acute Pancreatitis?

A

Alcohol

Gallstones (including microlithiasis)

Trauma/surgery

Acute discontinuation of medications for diabetes or hyperlipidemia

Following endoscopic retrograde cholangiopancreatography (ERCP)

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4
Q

What meds can cause acute pancreatitis?

A

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

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5
Q

What are 4 possible mechanisms of drug-induced acute pancreatitis?

A

direct toxic effects of the drug or its metabolites

hypersensitivity

drug-induced hypertriglyceridemia

alterations of cellular function in the pancreas and pancreatic duct

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6
Q

What is the 1st line tx for acute pancreatitis?

A

Fluid resuscitation: isotonic crystalloid solution— NS or LR

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7
Q

Why is fluid resuscitation given in acute pancreatitis?

A

to reduce the risks of SIRS and organ failure

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8
Q

What should you do if vomiting persists past fluid resuscitation in acute pancreatitis?

A

NPO or NG tube

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9
Q

Fluid resuscitation can be ____________ or _________.

A

Fluid resuscitation can be e__nteral or parenteral.

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10
Q

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?

A

Acute Pancreatitis

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11
Q

What should you advise pts with acute pancreatitis during discharge?

A

dietary modification to reduce dietary fats, alcohol, and added sugars

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12
Q

Long-standing and progressive destruction of pancreatic tissue due to persistent inflammation

Results in exocrine and/or endocrine insufficiency

Which type of pancreatitis?

A

Chronic Pancreatitis

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13
Q

What are the hallmark complications of Chronic Pancreatitis?

A

chronic pain

malabsorption with resultant steatorrhea

diabetes mellitus

risk of pancreatic cancer

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14
Q

What are the primary treatments for malabsorption due to chronic pancreatitis?

A

pancreatic enzyme supplementation

reduction in dietary fat intake

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15
Q

Which drug can cause an increase in sphincter of Oddi pressure?

A

Morphine

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16
Q

Why should you avoid Demerol in tx of acute pancreatitis?

A

porential of accumulation of a toxic metabolite normeperidine

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17
Q

What tx is no longer recommended for acute pancreatitis?

A

prophylactic abx

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18
Q

How do you tx pts with ascending cholangitis or necrotizing pancreatitis?

A

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.

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19
Q

What do you tx acute pancreatitis with if pt has cholangitis and pt is allergic to penicillin?

A

Levofloxacin

20
Q

What should you be vigilant for when giving prophylactic abx in acute pancreatitis?

A

fungal superinfections

21
Q

What are the tx options for chronic pancreatitis?

A

enteric-coated pancreatic enzyme supplements

antisecretory agent + pancreatic enzyme supplementation

22
Q

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?

A

Histamine2-receptor antagonist or proton-pump inhibitor

23
Q

What would adding an antisecretory agent to pancreatic enzyme supplementation help achieve?

A

may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea

24
Q

What are possible chronic pancreatitis txs?

A

Analgesics: tramadol, chronic opioid, gabapentin, pregabalin, SNRIs or TCAs, traditional pancreatic enzyme supplements

Uncoated enzymes (Viokase)

Octreotide

25
Q

Uncoated enzymes (Viokase) may be more efficacious for what sx when given with what other medication?

A

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.

26
Q

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

A

True

27
Q

When would you treat pts with corticosteroids?

A

autoimmune pancreatitis

28
Q

When should you administer pancreatic enzymes?

A

during or just after meals

29
Q

T/F: Products containing enteric-coated microspheres or minimicrospheres may be less effective than other dose forms

A

False; Products containing enteric-coated microspheres or minimicrospheres may be more effective than other dose forms

30
Q

Primarily used to treat malabsorption associated with chronic pancreatitis

also used to treat pain from the disease

Which drug?

A

Pancreatic Enzymes

31
Q

Relief of pain is thought to be due to their ability to break down CCK

Which drug?

A

Pancreatic Enzymes

32
Q

T/F: the release of CCK, which causes an increase in pancreatic secretion, is not inhibited by trypsin

A

False; the release of CCK, which causes an increase in pancreatic secretion, is inhibited by trypsin

33
Q

Which drugs cause a decrease in the production of trypsin in patients with chronic pancreatitis?

A

Pancreatic Enzymes

34
Q

Proteases in pancreatic enzymes supplements act as what?

A

substitutes for endogenous trypsin, leading to a decrease in CCK release

35
Q

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?

A

Celiac Disease

36
Q

Individuals with this disease have a sensitivity to gliadin fraction in glutens

Which disease?

A

Celiac Disease

37
Q

What is the pathology of Celiac Disease?

A

Immunologic cross-reactivity, inflammation, and tissue damage (villous atrophy) with subsequent malabsorption

38
Q

What does the mnemonic for Celiac Disease stand for?

A

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

39
Q

Which 4 things are overlooked as sources of gluten?

A
  1. oral prescription drugs
  2. nonprescription drugs
  3. vitamin and mineral supplements
  4. health and beauty aids and cosmetics
40
Q

What is the main tx for Celiac Disease?

A

remove gluten from the diet

41
Q

What are safe and palatable substitutes for gluten?

A

Rice, corn, soybean flour

Grains: uncontaminated oats, rice, corn, tapioca, quinoa, amaranth, sorghum

42
Q

What should the oat limit be if you have Celiac disease?

A

50-60g a day

43
Q

Levels of _________ normalize with gluten abstinence

A

IgA antigliadin

44
Q

What 5 medications would you use for refractory disease-case reports of Celiac disease?

A

Steroids

Azathioprine

Cyclosporine

Tacrolimus

Infliximab, alemtuzumab

45
Q

Nutritional deficiencies of what require supplementation?

A

vitamins (A, D, E, B12)

calcium

carotene

copper

zinc

folic acid

ferritin

iron

46
Q

T/F: Pneumococcal vaccination: celiac disease is associated with hyposplenism

A

True

47
Q
A

MJ- P2 E2 (19 decks)

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