Chronic Pancreatitis

Question 1

chronic calcifying pancreatitis

Answer 1

• due to recurrent bouts of pancreatitis
• pancreatic stones develop
• steatorrhea and DM are commonly associated
• often due to ALCOHOL, hereditary
• occasionally due to hypercalcemia or hypertriglyceridemia

Question 2

chronic obstructive pancreatitis

Answer 2

• due to pancreatic adenocarcinoma
• due to IPMN: tumor in pancreas, mucinous neoplasm in the pancreatic ducts
• due to post-pancreatic or post-traumatic strictures

Question 3

autoimmune pancreatitis

Answer 3

• systemic disease
• elevated IgG4 levels
• biopsy shows lymphoplasmocytic infiltrate
• confirmed by response to steroid trial

Question 4

alcoholic pancreatitis

Answer 4

• alcohol increases viscosity of pancreatic solutions resulting in plugs of protein (lithostathine)
• may cause sphincter of Oddi spasm
• causes loss of R protein which keeps pancreatic juices in solution
• loss of R protein leads to calcification in the pancreas and calcium carbonate stones

Question 5

complications of chronic pancreatitis

Answer 5

• pain, DM, pseudocysts, PANCREATIC CANCER (elevated CA - 19-9), steatorrhea, weight loss, malabsorption, SPLENIC VEIN THROMBOSIS, gastric varices without esophageal varices,

Question 6

lipase levels in steatorrhea

Answer 6

• 90% of lipase must be gone for steatorrhea to develop

Question 7

risk of ERCP

Answer 7

• can induce pancreatitis

Question 8

secretin test

Answer 8

• give IV secretin and collect gastric and duodenal fluid

- overall volume and bicarb will be lower in pancreatitis

Question 9

bentiromide test

Answer 9

• bentiromide has PABA which is cleaved by the pancreas, conjugated in the liver and then excreted in the urine
• if 50% of dose is found in urine it is considered a well functioning pancreas

Question 10

whole fats in feces

Answer 10

• pancreatic enzymes are not being released into duodenum

Question 11

spit fats in feces

Answer 11

• small bowel mucosal damage (celiac, whipples, crohns)

- fats are not being absorbed

Question 12

non-enteric coated pancreatic enzymes

Answer 12

• used to treat pancreatic pain by being available in the duodenum
• given with ANTACIDS to increase bioavailability
• HIGH IN PEPTIDASES

Question 13

enteric coated pancreatic enzymes

Answer 13

• used to treat steatorrhea to decrease diarrhea and malabsorption
• HIGH IN LIPASE and able to withstand stomach acid