Pancreatitis, GERD, Peptic Ulcer Disease Flashcards
Causes of Acute Pancreatitis
- Often due to gallstones or alcohol
- High triglycerides
Signs and Symptoms of Acute Pancreatitis
- Severe abdominal pain
- Elevations in pancreatic enzymes
- Self limiting, will often spontaneously resolve
Management of Acute Pancreatitis
- Pain relief
- Fluid replacement
- Prevention of complications
Pain managment in Acute Pancreatitis
- Initially IV then PO
- Morphine (1st choice)
- Meperidine (less effective and has active metabolites)
Maintain fluid status in acute pancreatitis
- Normal Saline is preferred
- Hyperglycemia can increase risk of secondary infections
Preventing complications in acute pancreatitis
- If diagnosed with acute necrotizing pancreatitis start antibiotics with in 48hrs and continue for 2 weeks
- DO NOT start antibiotics if not indicated by infection
- 500mg imipenem/cilastin q8hr
- Ciprofloxacin and metronidazole (if pt has a penicillin allergy)
Chronic pancreatitis
- Progressive inflammatory state
- Functional and structural damage
- Can go undiagnosed for many years
Treatment goals of Chronic pancreatitis
- Control pain
- Correct malabsorption
- Assess need for exogenous insulin
Pain management in Chronic pancreatitis
- Stop alcohol and tobacco use
- Eat small meals
- Low fat diet
- Acid suppressive therapy (AST)
- NSAIDs, APAP, tramadol
- Use narcotics if pain persists
Malabsorption correction in Chronic pancreatitis
- Reduce dietary fat <20g/meal
- Supplement with pancreatic enzymes (lipase 30,000 to 90,000 IU per meal)
Diabetes mellitus in Chronic pancreatitis
- Decrease in insulin production, due to loss of pancreatic function
- Assess glucose tolerance/need for exogenous insulin
GERD Therapy
1) Weight loss
2) Antacids
3) Surface agents
4) Histamine blockers
5) PPIs
Antacids
- Pro: quick onset
- Con: short duration
Surface agents
- Sucralfate
- Safe in pregnancy
- Promotes healing: forms a gum that protects the stomach
Histamine blockers
- More effective than antacids
- Pro: Longer duration of action
- Con: Longer onset, loses effectiveness with subsequent dosing
PPIs
- Most effective for GERD
- Helps to heal erosive esophagitis
- Pro: fast onset, long duration
- Con: Side effects, cost, drug interations
Peptic Ulcer Disease
- Ulcers due to
1) H. pylori
2) NSAIDs
3) Stress
Gastric Ulcers
- Caused by H. pylori or NSAIDs
- Symptoms worsen with food
Duodenal
- Caused by H. pylori or NSAIDs
- Symptoms get better with food
Non-variceal bleed
- Erosion of ulcer into an artery
- Can be insidious and fatal
Diagnosis of H. pylori
a) Breath test or stool antigen test (noninvasive)
b) Endoscopy (invasive)
-Drug interactions with tests
PPIs, bismuth, and antibiotics can interfere with breath and stool test
Treatment of H. pylori
- Duration is 14 days
- 3 drug regimen or 4 drug regimen
3 drug regimen
- 14 day therapy to treat H. pylori
1) PPI bid (or esomeprazole 40mg qd)
2) Clarithromycin 500mg bid
3) Amoxicillin 1g bid (use metronidazole if PCN allergy)
4 drug regimen
- 14 day therapy to treat H. pylori
1) PPI bid (or esomeprazole 40mg qd)
2) Subsalicylate 525mg qid
3) Metronidazole qid
4) Tetracycline, amoxicillin, or clarithromycin qid
