Wk 9 Flashcards
what’s the imaging of choice for diagnosing acute pancreatitis?
CT (can note inflammation of gland)
what are the possible complications of acute pancreatitis?
necrotizing pancreatitis fistula pseudocyst infxn pulmonary: atelectasis, pleural effusion, pneumonia, ARDS renal failure
which lab values are indicative of acute pancreatitis?
elev. serum amylase and lipase
elev. WBC count 12,000-20,000
elev. ESR, CRP
possibly hyperglycemia
how quickly and how long does serum amylase stay elevated?
rises 2-12 hrs after onset of acute pancreatitis
remains elev. for 3-5 days
what ND treatments are appropriate for acute pancreatitis?
- pancreatic rest (avoid solid food for 24 hrs, reintroduce fatty foods 3-6 days after light food is tolerated)
- fish oil once fatty foods are tolerated
- castor oil infused with Larrea tridentata (reduces inflammation)
- botanicals: belladonna, salvia miltorrhiza, calendula off., Yarnell’s formula
what are the uses and limitations of fecal chymotrypsin and elastase-1 testing?
- fecal chymotrypsin- low levels may indicate pancreatic insuff. or hypochlorhydria. May be falsely elev. with supplementation of pancreatic enzymes.
- fecal elastase-1 testing-low levels (lower than 200 ug/g) indicate exocrine insufficiency, chronic pancreatitis, and cancer. Accurate even with pancreatic enzyme supplementation (makes it the test of choice)
what is the etiology of pancreatic insufficiency?
- overeating
- bad diet (low fiber,high sugar,excess CHO/EtOH, excess caffeine)
- lack of raw food in the diet
- def. of zinc, manganese, magnesium, protein, & Vit B6
- H. pylori, giardia, SIBO
- hypothyroidism, hypoadrenalism
- poor food hygiene
- Celiac dz
- cow milk enteropathy
what is the etiology for chronic pancreatitis?
- alcoholism (60-70%!!!)
- idiopathic
- obstruction of pancreatic duct
what is the gold standard for diagnosing chronic pancreatitis?
Abdominal X-ray or CT (if pancreatic calcification evident, dx is definitive)
*labs & imgaging can be normal
what is the classic triad for chronic pancreatitis?
DM
steatorrhea
pancreatic calcification
*usu presents late in dz
what are the dietary consideration in chronic pancreatitis?
- increase foods rich in Vit A, C, D, K, calcium, B12 & folic acid
- avoid all animal foods except fish
- incr fruits, vegetables, nuts, legume intake
- incr fluids
- incr olive oil, coconul oil, fish oil
- avoid spicy, salty, fatty, caffeine, sweets, tofu, shellfish
- *elimination of EtOH and tobacco
what therapies are useful for chronic pancreatitis?
- pancreatic enzymes (lipase!)
- fat soluble vitamins, Vit C, Mg & Se
- castor oil pack, vinegar pack, constitutional hydrotherapy, alt hot & cold to abdomen
- botanicals-Spasmolytic Herbs (Viburnum opulus, Dioscorea villosa, Valeriana off), Analgesic herbs (Belladonna, Gelsemium, Pulsatilla), Antifibrotic herbs (Centella asiatica, Silybum marianum, Scutellaria, Colchiicum)
- Homeopathics (Belladonna, Carbo animalis, Conium, Iodium..)
why is pancreatic cancer so often missed in diagnosis?
- onset of ssx are subtle and nonspecific…gradual (malaise, fatigue, nausea, anorexia, mid-epigastric/back pain)
- at Dx, 90% of pt’s CA have mets
which two tumor markers are helpful in diagnosis of pancreatic cancer?
CA 19-9- major useful tumor marker bc highly specific for malignancy of pancrease but not good at early detection and not helpful for screening bc of low sensitivity
CEA- minimal utility in pancreatic carcinoma bc other benign and malignant conditions lead to elev. CEA levels
what are the primary means for prevention of pancreatic cancer?
smoking cessation
maintain a healthy weight, regular exercise, and healthy diet
stress management
