Slide 2 GI

What is the pancreatic enzyme responsible for carbohydrate digestion? A. Lipase B. Amylase C. Protease D. Trypsin

B. Amylase

Which statement describes pancreatic beta and alpha cell function? A. Alpha cells secrete insulin and beta cells secrete glucagon B. Beta cells secrete insulin and alpha cells secrete glucagon C. Delta cells secrete insulin and alpha cells secrete glucagon D. Beta cells secrete glucagon and alpha cells secrete insulin

B. Beta cells secrete insulin and alpha cells secrete glucagon

What is the pathophysiology of pancreatitis? A. Increased bile production B. Autoimmune RBC destruction C. Build-up of pancreatic enzymes within the pancreas D. Decreased insulin secretion

C. Build-up of pancreatic enzymes within the pancreas

What are the main causes of acute pancreatitis? A. Alcohol, hypertriglyceridemia, gallstone disease B. Hypertension, diabetes, obesity C. Viral infection, anemia, dehydration D. IBS, GERD, ulcers

A. Alcohol, hypertriglyceridemia, gallstone disease

Which medications are associated with acute pancreatitis? A. Metformin, insulin, statins B. Cimetidine, corticosteroids, enalapril, furosemide, octreotide, opiates, sulfamethoxazole/trimethoprim (bactrim) C. Amoxicillin, azithromycin, doxycycline D. Aspirin, acetaminophen, ibuprofen

B. Cimetidine, corticosteroids, enalapril, furosemide, octreotide, opiates, sulfamethoxazole/trimethoprim

What are GI signs/symptoms of acute pancreatitis? A. Constipation with hyperactive bowel sounds B. N/V with relief after vomiting C. N/V without relief, abdominal distension and tympanic, decreased bowel sounds D. Diarrhea with increased bowel sounds

C. N/V without relief, abdominal distension and tympanic, decreased bowel sounds

What is required to diagnose acute pancreatitis? A. One criterion only B. Two of: abdominal pain, lipase/amylase >3x ULN, imaging findings C. Only imaging findings D. Only elevated WBC count

B. Two of: abdominal pain, lipase/amylase >3x ULN, imaging findings

What are complications of acute pancreatitis? A. Asthma, hypertension, anemia B. Organ failure, SIRS, respiratory failure, pancreatic necrosis C. Kidney stones only D. Liver cirrhosis only

B. Organ failure, SIRS, respiratory failure, pancreatic necrosis

What are SIRS criteria? A. HR <60, normal WBC B. Fever, HR >90, WBC >12,000 or <4,000 C. Hypotension and bradycardia D. Hyperglycemia only

B. Fever, HR >90, WBC >12,000 or <4,000

What are the goals of treating acute pancreatitis? A. Increase pancreatic secretion B. Pain/nausea control, fluid replacement, prevent necrosis C. Lower cholesterol D. Increase appetite only

B. Pain/nausea control, fluid replacement, prevent necrosis

What are nonpharmacologic interventions for acute pancreatitis? A. High-fat diet immediately B. NPO, early low-fat feeding (24–48 hrs), tube feeds if NPO >3 days C. No feeding ever D. High-protein diet only

B. NPO, early low-fat feeding (24–48 hrs), tube feeds if NPO >3 days

Elevated BUN indicates what? A. Infection B. Dehydration C. Liver failure D. Hyperglycemia

B. Dehydration

How is abdominal pain in acute pancreatitis treated? A. Oral NSAIDs only B. Avoid analgesics C. Parenteral opioids like morphine via PCA D. Antidepressants only

C. Parenteral opioids like morphine via PCA

Which antibiotics are used for infected acute pancreatitis? A. Macrolides only B. Carbapenems, quinolones, metronidazole C. Penicillins only D. Antifungals only

B. Carbapenems, quinolones, metronidazole

What are the stages of chronic pancreatitis? A. Reverse order B. Stage 1 inflammatory → Stage 2 acute attacks → Stage 3 intermittent/constant pain → Stage 4 minimal pain with malabsorption/diabetes C. Single stage D. No stages

B. Stage 1 inflammatory → Stage 2 acute attacks → Stage 3 intermittent/constant pain → Stage 4 minimal pain with malabsorption/diabetes

What causes chronic pancreatitis? A. Viral infection only B. Oxidative stress, toxic metabolites, ductal obstruction, recurrent acute pancreatitis C. Trauma only D. Diet only

B. Oxidative stress, toxic metabolites, ductal obstruction, recurrent acute pancreatitis

What are symptoms of chronic pancreatitis? A. Hypertension and tachycardia B. Malnutrition, abdominal pain/mass, jaundice, steatorrhea, diarrhea, osteoporosis, dyspepsia C. Rash and fever only D. Cough and dyspnea only

B. Malnutrition, abdominal pain/mass, jaundice, steatorrhea, diarrhea, osteoporosis, dyspepsia

What are complications of chronic pancreatitis? A. Asthma B. Diabetes, infection, malignancy C. Kidney stones D. Stroke

B. Diabetes, infection, malignancy

What is the treatment for malabsorption/steatorrhea in chronic pancreatitis? A. No treatment B. Pancreatic enzyme supplements, increase dose, add H2RA/PPI, reduce fat intake C. Antibiotics only D. Steroids only

B. Pancreatic enzyme supplements, increase dose, add H2RA/PPI, reduce fat intake

What is required when using Viokace (non–enteric-coated pancrelipase)? A. Take alone B. Must be taken with a PPI or H2RA C. Take with insulin D. Take with antibiotics

B. Must be taken with a PPI or H2RA

What is the pain management approach in chronic pancreatitis? A. Opioids first only B. Analgesics → adjuvants → opioids → ERCP/surgery if refractory C. No treatment D. Antibiotics first

B. Analgesics → adjuvants → opioids → ERCP/surgery if refractory

Which drugs are adjuvant therapies for chronic pancreatitis pain? A. Insulin B. Pregabalin, SSRIs (paroxetine), SNRIs (duloxetine) C. Antibiotics D. Antihistamines

B. Pregabalin, SSRIs (paroxetine), SNRIs (duloxetine)

Which opioid is used for chronic pancreatitis pain? A. Morphine IV PCA B. Tramadol 50–100 mg q4–q6 C. Fentanyl patch only D. Codeine only

B. Tramadol 50–100 mg q4–q6

What should be monitored in chronic pancreatitis? A. Blood pressure only B. Laxatives with opioids, weight/stool consistency, blood glucose C. Liver enzymes only D. ECG only

B. Laxatives with opioids, weight/stool consistency, blood glucose

What is a rare but serious adverse effect of pancrelipase? A. Kidney failure B. Fibrosing colonopathy C. Liver toxicity D. Lung fibrosis

B. Fibrosing colonopathy