Pancreatitis, Diverticulitis Flashcards
What happens in pancreatitis?
Early activation of enzymes inside the pancreas causing auto digestion
-etiology: alcohol, gall stones, acutely stopping of hyperlipdemia and diabetes medications
Which meds can cause pancreatitis?
- ACE-I
- simvastatin HMG-CoA reductase
- steroids
- TMP-SMX
How do you treat pain in pancreatitis?
Hydromorphone
Fentanyl
Morphine
DONT USE MEPERIDINE
Which abx do you use to tx pancreatitis?
- don’t use as prophylaxis
- for cholangitis or necrotizing pancreatitis use Beta-lactam inhibitor: Pip/Tazo
- use levofloxacin for those who have a penicillin allergy
- monitor for fungal infections
Which fluid resuscitation is given in pancreatitis?
NS or LR
Which diet modification are made for pancreatitis?
- NPO
- oral intake only after pain has resolved
- on discharge give reduce fat, eliminate alcohol and don’t eat sugars
What is chronic pancreatitis
progressive destruction of pancreas from exocrine and endocrine function
What are hallmark signs of chronic pancreatitis?
steatorrhea
DM
pancreatic cancer
How do you treat pancreatic malabsoprtion?
enzymes
reduce fat intake
T/F Pancreatic enzymes treat pain and malabsorption
True
* pain is caused by the inability to breakdown CCK , enzyme supplements provide trypsin which can break down and resolve the pain
What is recommended dosage of enzymes for pancreatitis?
50,000-75,000 IU before each meal
- enteric coated enzymes used
- addition of PPI and
What do pancreatic enzymes contain?
amylase
lipase
protease
What analgesics are used for chronic pancreatitis?
Tramadol-first line
- morphine
- Gabapentin, pregabalin, SNRI’s ,TCA adjunctive therapy
What do you give for autoimmune pancreatitis?
corticosteroids
If a pancreatic fistula exist what can you give?
Octreotide- sub Q or IV
What is Celiac’s disease?
immune mediated rxn to wheat gluten, rhye
What does celiac’ disease affect?
small intestine
gene associated with celiacs: HLA-DQ2/DQ8
will test positive for IgA tTG
What are some overlooked sources of celiac’s disease?
Oral rx drugs
non-prescrition drugs
vitamin and herbal supplements
How do you tx celiac’s disease?
- remove gluten fro diet
2.give A,D,E, B12, and K vitamins - Pneumococcal vaccination: celiac’s is associated with hyposplenism
4 Refractory cases: give Steroids, cyclosporine, infliximab
What are signs of acute diverticulitis?
LLQ pain
leukocytosis
NO peritoneal signs
How do you treat uncomplicated diverticulitis?
- Add fiber/bulking agents >30grams/day
- Abx: metronidazole and cipro/levo 7-10 days
alternate: TMP-SMX and metronidazole
2nd line: Augmentin or Moxifloxacin an metronidazole
