Uw revision chronic pancreatitis 03-05 (2)

Question 1

etiology?

Answer 1

alcohol use (chronic)
CF (common in children)
Ductal obstruction (eg malignancy, stones)
Autoimmune

Question 2

CP? 3

Answer 2

CHRONIC EPIGASTRIC PAIN - partially relieved by leaning forward or sitting upright; pain-free intervals

MALABSORPTION - steatorrhea, weight loss

DM

Question 3

Labs. Lipase amylase?

Answer 3

NONDIAGNOSTIC!!!!!!!! because pancreas are tired, do not produce them!!! levels normals or decr.

Question 4

Imaging?

Answer 4

Use this to make Dx

CT - calcifications, dilated ducts and enlarged pancreas

Question 5

Tx? 4

Answer 5

Pain management
Alcohol and smoking cessation
Frequent, small meals
PANCREATIC ENZYME SUPPLEMENTATIONS

Question 6

Exocrine enzymes deficiency CP?

Answer 6

Diarrhea, steatorrhea, weight loss

Question 7

Endocrine enzymes deficiency CP?

Answer 7

DM

Question 8

CCK levels in chronic?

Answer 8

increased

Pancreatic enzymes breakdown CCK-releasing protein, thereby limiting CCK release. In pancreatic deficiency = high volumes of CCK –> this also leads to hyperstimulation of pancreas. ======> post-prandial abdominal pain

Question 9

what supplements? 3

Answer 9

Lipase, protease, amylase

Question 10

How helps supplements?

Answer 10

Alleviates pain by reducing pancreatic hyperstimulation and improves nutrient digestion

Question 11

Secondary Tx of pain (apart from supplements)?

Answer 11

pregabalin, nortriptyline, amitriptyline

Question 12

If secondary pain Tx fails?

Answer 12

just then give opioids

Question 13

For what is celiac plexus block?

Answer 13

for pancreatic cancer, but has limited efficacy in chronic pancreatitis

Question 14

Pancreatic adenocarcinoma. CP? 4

Answer 14

Systemic symptoms - weight loss, anorexia
Discomfort/subacute pain (abdomen, back)
Jaundice
Unexplained migratory superficial thrombophlebitis

Question 15

Pancreatic adenocarcinoma. labs/imaging?

Answer 15

Cholestasis (incr. ALP/direct bilirubin)
Incr. cancer assoc. antigen 19-9 (NOT AS DIAGNOSTIC TEST!!!)
UG (pancreatic head mass) or CT (ill-defined pancreatic mass).

Question 16

Pancreatic adenocarcinoma - 60-70 proc. in head. CP?

Answer 16

JAUNDICE (common bile duct obstruction with incr. ALP and bilirubin) and steatorrhea

Question 17

Pancreatic adenocarcinoma - 60-70 proc. in head. Preferred imaging?

Answer 17

Abdominal UG

Question 18

Pancreatic adenocarcinoma - 30 proc. tail. CP?

Answer 18

Does not present with obstructive jaundice!!!!!

Question 19

Pancreatic adenocarcinoma - 30 proc. tail. preferred imaging?

Answer 19

abdominal CT with contrast

Ug in this case is less sensitive

Question 20

Pancreatic adenocarcinoma. whats about 19-9?

Answer 20

assoc with cancer, but not used to screen and also normal levels does not rule out diagnosis.

Question 21

Pancreatic adenocarcinoma. ERCP?

Answer 21

If cholestasis present and intervention (eg stenting) needed.

Question 22

cia buvo vienas is ats variantu: secretin test measures the ability of pancreatic ductal cells to produce bicarbonate. useful in diagnosing chronic panceatitis.

Answer 22

.

Question 23

Severe pancreatitis definition?

Answer 23

Pancreatitis + at least 1 other system (eg Shock/ resp/ renal failure)

Question 24

Severe pancreatitis can cause increased systemic permeability (pancreatic enzymes incr. permeab).

Answer 24

.

Question 25

Severe pancreatitis imaging?

Answer 25

if suspected, DO ABDOMINAL CT!!!!!! Look for pancreatic necrosis and extrahepatic inflammation

Question 26

Severe pancreatitis –> systemic permeability –> fluid migrate from intravascular to extravascular compartment. Net result?

Answer 26

widespread vasodilation, capillary leak, shock, and assoc. end-organ damage

Question 27

Severe pancreatitis. pseudocyst vs incr. permeability?

Answer 27

pseudocyst takes 3-4 weeks to develop!!!!!!