Pancreatitis- Ochs - Exam 3

based off pp

What are some of the causes of acute pancreatitis?

• gallstones

• alcohol

• hypertriglyceridemia

• cigarette smoking

• diseases: CF, Crohn’s

• medications

What are some medications that are associated with causing pancreatitis?

• 5-ASA, mercaptopurine, mesalamine

• azathioprine, sulfasalazine

• valproic acid

• liraglutide

What are some symptoms of acute pancreatitis?

• mild abdominal pain—> excruciating pain, distended, tender abdomen

What lab tests are elevated in pancreatitis?

amylase and lipase

How is acute pancreatitis diagnosed? How many criteria do you need to diagnose?

NEED 2 out of 3 criteria

1. abdominal pain

2. serum lipase/amylase 3x normal

3. characteristic findings on imaging

What are the main complications of acute pancreatitis?

• systemic inflammatory response syndrome (SIRS)

• organ failure

What are the 4 key components of acute pancreatitis treatment?

1. pain control

2. fluid management

3. nutrition

4. antibiotics

For pain control of acute pancreatitis, what is 1st used. What is used if that is not enough?

FIRST try NSAIDs or APAP, SECOND try opioids

For fluid management of acute pancreatitis, what is normally used? Are they normally given IV infusion or IV bolus?

IV infusion of normal saline/lactated ringers

For nutrition replacement in acute pancreatitis, what route is preferred if NPO?

nasogastric tube

When are antibiotics used in acute pancreatitis?

ONLY IF THERE IS AN INFECTION!!!! DO NOT USE FOR PROPHALAXIS

What is the leading cause of chronic pancreatitis?

chronic alcohol consumption

What the signs and symptoms of chronic pancreatitis?

signs: malnutrition, mass, jaundice

symptoms:

• epigastric pain that may be relieved by bending/leaning, and is worse with meals or at night

• steatorrhea

• fat-soluble vitamin deficiencies

• diabetes

• weight loss

• osteoporosis

What’s the difference in abdominal pain between acute and chronic pancreatitis?

acute is a constant pain, while in chronic the pain may be relieved by things like bending/leaning

How is chronic pancreatitis diagnosed?

mainly based off signs/symptoms, imaging, ERCP invasive study

How can pain be controlled in chronic pancreatitis? (1st, 2nd, and 3rd option)

1st- APAP or NSAIDs prior to meals (OTC)

2nd- adjuvant agent like pregabalin, gabapentin, paroxetine, duloxetine

3rd- opioids

When are pancreatic enzymes used in chronic pancreatitis?

steatorrhea and weight loss

Which pancreatic enzymes are preferred?

a. immediate release

b. Enteric coated

c. delayed release

b

When pancreatic enzymes are ineffective for steatorrhea, what is used?

H2RA or PPIs

What are the ADRs of pancreatic enzymes?

• n/d

• fibrosing colonopathy

WHAT IS THE STARTING DOSE FOR PANCREATIC ENZYMES for chronic pancreatitis? What is the dosed based on?

500-1000 units/kg/meal of lipase with each meal and half the dose for snacks (dose is based on LIPASE component)

What is the only pancreatic enzyme product that is IR, must be taken with a PPI, and has another use for clearing clogged feeding tubes?

Viokace

PRACTICE:

What are the complications of chronic pancreatitis?

• cancer

• diabetes

• osteoporosis

• fat vitamin malabsorption

• weight loss

PRACTICE:

How can a patient with chronic pancreatitis reduce their risk of developing pancreatic cancer?

stop drinking and smoking