Chronic Pancreatitis

Question 1

What is the triad of chronic hepatitis?

Answer 1

1. acinar loss
2. mononuclear cell infiltration
3. fibrosis

Question 2

How much of the pancreas must be damaged before mal-digestion of fat and protein is identified?

Answer 2

90%

Question 3

What can pancreatitis initially present as?

Answer 3

high incidence of hyper and hypo glycemia

Question 4

What are the causes of chronic pancreatitis?

Answer 4

1. alcoholic
2. autoimmune
3. toxic causes
4. genetic
5. idiopathic

Question 5

What is autoimmune pancreatitis usually stimulated by?

Answer 5

H. pylori

Question 6

What genetic mutations are correlated with chronic pancreatitis?

Answer 6

SPINK 1 function
CFTR deficiency

Question 7

What causes tropical pancreatitis?

Answer 7

cyanogenic glycosides in cassava

Question 8

What toxicities cause chronic pancreatitis?

Answer 8

inhaled hydrocarbons:
1. cigarette smoke
2. kerosene

Question 9

What are clinical features with chronic features?

Answer 9

1. pain
2. fatty stools
3. diabetes
4. malnutrition
   (2-3 can be interchanged)

Question 10

What are the presentations of chronic pancreatitis?

Answer 10

1. recurrent acute pancreatitis
2. Constant/radiating pain
3. jaundice
4. steatorrhea
5. diabetes
6. fatty stools

Question 11

What laboratory tests are related to chronic pancreatitis?

Answer 11

1. diabetes
2. hyperlipidemia
3. hypercalcemia
4. abnormal LFTs

Question 12

When is a stepwise approach to chronic pancreatitis dose not needed?

Answer 12

presentation of fatty stool
AND
long history of pancreatitis attacks or pain

Question 13

What is the first line treatment for pain related to chronic pancreatitis according to WHO guidelines?

Answer 13

Acetaminophen or NSAIDs prn

Question 14

What is the second-line treatment (chronic first-line therapy) for pain related to chronic pancreatitis according to WHO guidelines?

Answer 14

Tramadol

Question 15

What is the third-line treatment for pain related to chronic pancreatitis according to WHO guidelines?

Answer 15

Pregabalin
TCAs
SSRIs

Question 16

What agents should be avoided in chronic pancreatitis for pain?

Answer 16

narcotics

Question 17

What is the DOC for chronic pain control?

Answer 17

Tramadol

Question 18

What is the MOA of trmamdol?

Answer 18

mu-receptor agonist

Question 19

What are SEs with Tramadol?

Answer 19

dizziness
constipation
peripheral edema
seizures

Question 20

A decrease in _______ _______ increases likely hood of seizures

Answer 20

renal clearance

Question 21

Which agent is FDA-approved for pain with chronic pancreatitis?

Answer 21

Pregabalin

Question 22

What are SEs with Pregabalin?

Answer 22

peripheral edema
CNS toxicity
weight gain

Question 23

What is an alternative treatment to manage pain with chronic pancreatitis?

Answer 23

pancreatic enzymes correct stool consistency, reducing pain

Question 24

How are flares prevented?

Answer 24

avoid alcohol
smoking cessation
manage hypertriglyceridemia
avoid trigger foods

Question 25

What are signs of malabsorption?

Answer 25

1. diarrhea 2. steatorrhea 3. weight loss 4. metabolic bone disease 5. vitamin / mineral deficency

Question 26

What is required for diagnosis of steatorrhea?

Answer 26

72-hour analysis of fecal fat concentration while on a high-fat diet OR clinical symptoms of steatorrhea AND low levels of fecal elastase

Question 27

How are pancreatic enzyme therapy formulated to prevent degradation by acid in the stomach?

Answer 27

enteric coating

Question 28

What is the dose of pancreatic enzymes taken with every meal?

Answer 28

30,000-50,000 IU

Question 29

What is the dose of pancreatic enzymes taken with snacks?

Answer 29

1/2 dose taken with meals

Question 30

How is failure to respond to pancreatic enzymes monitored?

Answer 30

diarrhea weight gain increase in ADEK (fat soluble) vitamin levels

Question 31

What is the pancreatic enzyme drug of choice if prior gastric surgery or hypochlorhydria? Why?

Answer 31

Viokace (non-enteric coated)

Question 32

Are pancreatic enzyme products interchangeable?

Answer 32

no, not A/B rated

Question 33

What are all pancreatic enzyme therapies derived from?

Answer 33

porcine, pig

Question 34

What must Viokace be administered with since it is not enteric coated?

Answer 34

PPI

Question 35

How should pancreatic enzyme therapy be taken?

Answer 35

WITH meals, spread out dose if eating a long meal

Question 36

Can pancreatic enzyme therapy be crushed or chewed?

Answer 36

no only some products can be opened and put in applesauce (Pancreaze)

Question 37

What is recommended to manage diabetes with chronic pancreatitis?

Answer 37

simple insulin regimens