CC Chronic Pancreatitis

echoecho's version from 2018-04-26 02:34


Question Answer
Define chronic pancreatitis?An inflammatory disease of the pancreas that causes scarring of pancreatic tissue, resulting in permanent loss of function and chronic pain
What is the most common cause of chronic pancreatitis?Chronic excessive alcohol use
What are the other etiologies of chronic pancreatitis?1) toxic-metabolic 2) idiopathic 3) genetic 4) autoimmune 5) recurrent acute pancreatitis 6) obstructive
Patients with chronic pancreatitis often present with vague symptoms?Pain, nausea, anorexia, weight loss and diarrhea
In contrast to acute pancreatitis where pain is sudden, persistent and a constant feature, pain in chronic pancreatitis is what?Mild to sever and varie greatly ranging from constant to intermittent, abdominal or back, sharp or dulll
In chronic pancreatitis, comment on food intake?Food intake may precipate pain, causing fear of eating and weight loss
In chronic pancreatitis, comment on amylase and lipase levels?Are often normal making diagnosis more challenging
Why is early dx difficult in chronic pancreatitis?Due to the nonspecific presentation and lack of a specific marker for the disease so chronic pancreatitis is often incidentally discovered at autopsy
Normal pancreatic exocrine function is responsible for production of enzymes needed in digestion of what?Carbohydrates, proteins and fats
Loss of exocrine function is a late feature of chronic pancreatitis and results in what1) steatorrhea 2) weight loss 3) impairment in absorption of fat-soluble vitamins (A, D,E, K ) as well as other nutrientts
List the complications of chronic pancreatitis?pti1) malabsorption 2) biliary stricture 3) gastroparesis 4) metabolic bone disease 5) chronic pain 6) narcotic addiction 7) a significantly increased risk of pancreatic cancer
Loss of endocrine function occurs very late in the disease process and can result in reduction in _____ production and diabetes mellitus?Insulin
*** Why is abdominal CT the initial modality of choice?1) It can r/o pseudocyst and cancer 2) it can demonstrate calcification, dilated ducts and pancreatic atrophy
*** When is MRI and MRCP also helpful for diagnosis?In cases where results from an abdominal CT scan is equivocal
*** Why is endoscopic US not the initial test of choice? Although it is a valuable modality for diagnosis, there is need for a skilled operator and its invasive nature
*** How about plain radiographs?Can identify pathognomonic pancreatic calcification, but is not sensitive
Abdominal US can also be a useful initial diagnostic imaging for presumptive chronic pancreatitis w/ a specificity of ____% to ___%, and but it has a lower sensitivity of ___% to ___%?70-97%; 60-81%
Newer technologies and processors can detect what?Parenchymal changes (inflammation, destruction, ductal dilation, intra-ductal calcification and development of pseudocysts, however US studies can slo be non revealing and limited by overlying bowel gas and body habits
What testing may help determine the extent of exocrine and endocrine dysfunction?lab
What labs can be done to indicate the degree of endocrine dysfunction?blood glucose levels; HgbA1c and insulin levels
A 72 hour fecal fat test is the gold standard to assess _____ function but is difficult to obtain. What test can be performed on a single stool specimen and is both sensitive and specific?exocrine; fecal elastase
Management of pain of chronic pancreatitis is challenging. All ______ intake must stop?alcohol
*** What treatment is considered a good starting point, why?oral pancreatic enzymes treat exocrine dysfunction and may provide pain relief in some patients. It is believed that use of oral pancreatic enzymes suppresses endogenous enzyme producation and secretion that contributes to pain through tissue destruction
Why does response to pancreatic enzymes vary greatly?because the degree of exocrine dysfunction does not correlate with pain intensity
Why are pancreatic enzymes most effective?it is unclear
Coated or microencapsulated enzymes are protected from gastric degradation but may not release enzymes in the _____ where they are most effective?duodenum
Non-coated enzymes maybe denatured by the ______ environment of the stomach, requiring co-administration of what meds?acidic; acid blockers
When are the enzymes best taken?with the onset of the meal and possibly again after eating
Failure of benefit with pancreatic enzyme supplementation may also be due to what?unrecognized gastroparesis and thus, the addiction of prokinetic medications may be useful in this setting
If pancreatic enzymes fail to control pain, what medications can be offered? For refractory cases, what med can be used?1) anti-inflammatory agents, antioxidants, gabapentin or pregabalin. 2) Opioids
When is surgery indicated?it is rarely necessary for decompression of large duct disease and strictures; stones and pseudocysts may be approached endoscopically
A pancreatic duct stent may also be placed, although long-term outcomes are not well defined, true or false?true
Endoscopic drainage, stone retrieval and duct dilation may help in some situations, but in severe cases, what can be done to the affected pancreatic tissue?nerve blocks and neurolysis
Surgical drainage of what may also provide relief? pseudocysts and dilated ducts
Is partial pancreatectomy necessary? How about complete pancreatectomy?1) rarely be necessary 2) may be accompanied by islet cell transplantation
*** SUMMARY = Chronic pancreatitis can bed asymptomatic or may present with pain of variable severity? True or false?true
*** SUMMARY = Advanced cases cause malabsorption due to exocrine dysfunction. Treatment is with what?oral administration of pancreatic enzymes
*** SUMMARY = Insulin deficiency and ____ ____ occur late in the disease process?diabetes mellitus