Pancreas

Question 1

What imaging is best for diagnosing acute pancreatitis?

Answer 1

CT scan

-Can note inflame. of gland

Question 2

Possible complications of acute pancreatitis

Answer 2

1. Necrotizing Pancreatitis
2. Fistula
3. Pseudocyst
4. Infx
5. Pulmonary probs:
   * Atelectasis, pleural effusion,pneumonia, ARDS
6. Renal failure

Question 3

Which lab values are indicative of acute pancreatitis?

Answer 3

elevated serum Amylase and Lipase
elevated WBC count 12,000-20,000
elevated ESR, CRP
mb hyperglycemia

Question 4

Serum amylase: How quickly and long does it stay elevated?

Answer 4

rises 2-12 hrs of onset of acute pancreatitis
elevated for 3-5 d
3x normal

Question 5

What ND treatments are appropriate for acute pancreatitis?

Answer 5

• if not severe, it usu improves on its own
• let the pancreas rest
  - avoid solid food for a couple days
  - reintroduce fatty foods later (3-6 d after light food toleration)
  - then try fish oil
• if severe, IV nutrition

Question 6

What is the etiology of pancreatic insufficiency?

Answer 6

1. Overeating
2. Bad diet (low fiber, high sugar, excess CHO, excess booze/caffeine)
3. Deficiency of minerals (Mn, Zn, Mg)
4. Deficiency of protein, vit B6
5. Gut infx/overgrowth (giardia, SIBO, H. pylori)
6. Hypothyroid
7. Hypoadrenalism
8. Hypochlorhydria
9. Dysglycemia, Insulin Resistance (Diabetes)
10. Gluten/Casein Enteropathy

Question 7

What 2 other etiologies may cause pancreatic insufficiency?

Answer 7

a. Celiac disease role in pancreatic insufficiency
20% have PI

b. Cow Milk Enteropathy role in pancreatic insufficiency
correlated w PI along w dairy intolerance

Question 8

Chronic pancreatitis etiologies?

Answer 8

• ALCOHOLISM (70-80%)
• Idiopathic
• Hereditary
• Hyperparathyroidism (High PTH->High Calcium levels) *Obstruction of pancreatic duct (stones)
• Cancer

Question 9

Gold standard testing to diagnose chronic pancreatitis?

Answer 9

Gold Standard Dx Chronic Pancreatitis:
1. ERCP (Endoscopy-Gold standard)
Labs and imaging mb normal
(*Dx can be made if And X-ray or CT shows pancreatic calcifications)

2. Classic triad: DM, steatorrhea, pancreatic calcifications
   (usu late in the Dz)
3. Alcoholism
4. Hx of abd pain

Question 10

Dietary considerations in chronic pancreatitis?

Answer 10

• Good fats, not animal fats or foods except fish
• Increase veg., fruit, nuts, legumes, fluids
• ELIMINATE ALCOHOL AND TOBACCO
• Avoid spicy, salty, fatty, caffeine, sweets, tofu, shellfish

Question 11

Therapies useful for chronic pancreatitis?

Answer 11

1. LIPASE!–>Pancreatic Enzymes (non-enteric coated)
2. Fat Soluble Vitamins, Mg, Se
3. Compresses
   (Castor oil, vinegar, constitutional hydro, alt. hot/cold)
4. Botanicals
5. Homeopathies
6. Manipulation (Chapman’s Reflex)

Question 12

Homeopathics useful for chronic pancreatitis?

Answer 12

Achillea millefolium: as compress
Aconitum napellus (toxic): acute, according to indications
Bryonia alba (toxic): according to indications
Chionanthus virginica: obstruction of bile ducts due to duodenitis
Inula helenium
Matricaria chamomile – decrease inflammation and promote healing

Question 13

Compresses useful for chronic pancreatitis?

Answer 13

1. Castor oil (Inc. Lymphocytes =>Healing),
2. Vinegar,
3. Constitutional hydro,
4. Alt. hot/cold

Question 14

Pancreatic cancer – why is this condition so often missed?

Answer 14

*Onset of sxs are subtle and nonspecific… gradual
Malaise, fatigue, nausea, anorexia, mid-epigastric/back pain

*@ Dx, 90% pt’s CA have mets

Question 15

Primary means of prevention of pancreatic cancer?

Answer 15

• Quit smoking
• Maintain healthy weight, regular exercise, healthy diet
• Stress management

Question 16

Treatment options in pancreatic cancer?

Answer 16

1. Diet:
   short fasts, blood sugar management, low animal fats, avoid meat, spicy, salty, fried, processed foods
2. Exercise, Decrease Stress
3. Supplements:
   A, C, E, Selenium, maitake, multivit/mineral
4. Botanicals:
   viscous album, avena sativa, baptisia tinctoria, conium maculatum, trifolium pratense, rumex crispus, taraxacum off, phytolacca decandra, gentiana lutea, etc.
5. Homeopathy:
   Calcarea arsenicosa, Conium maculatum, Iodum, Iris versicolor, Phosphorus, Silicea

Question 17

Diet tx’s options in pancreatic cancer?

Answer 17

1. Diet:

short fasts, blood sugar management, low animal fats, avoid meat, spicy, salty, fried, processed foods

Question 18

Supplemental tx’s options in pancreatic cancer?

Answer 18

A, C, E, Selenium, maitake, multivit/mineral

Question 19

Botanicals & Homeopathic tx’s options in pancreatic cancer?

Answer 19

1. Botanicals:
   viscous album, avena sativa, baptisia tinctoria, conium maculatum, trifolium pratense, rumex crispus, taraxacum off, phytolacca decandra, gentiana lutea, etc.
2. Homeopathy:
   Calcarea arsenicosa, Conium maculatum, Iodum, Iris versicolor, Phosphorus, Silicea

Question 20

Know the uses and limitations of chymotrypsin and elastase-1 testing

Answer 20

Chymotrypsin: low levels may indicate pancreatic insuff. or hypochlorhydria

Fecal Elastase-1: conc. of pancreatic elastase-1 enzyme in fecal matter w ELISA
*Exocrine Insufficiency/Chr. Pancreatitis/Cancer

Question 21

Tumor markers that can be helpful diagnosis?

“Carbohydrate Ag 19-9”, (CA 19-9)

Answer 21

Useful!!!
Elevated [in 75-85% pt w pancreatic carcinoma]
in absence of biliary obstruction or benign pancreatic dz
not effective for early stage Dx (least sensitive)
not useful for screening

Question 22

Tumor markers that can be helpful diagnosis?

“Carcinoembryonic Ag”, (CEA)

Answer 22

Other benign and malignant conditions → elevated CEA
so not specific
40-45% of pt w pancreatic CA have elevated CEA

Question 23

Uses and limitations of chymotrypsin

Answer 23

Low levels may indicate pancreatic insuff. or hypochlorhydria

Question 24

Uses and limitations of elastase-1 testing

Answer 24

Conc. of pancreatic elastase-1 enzyme in fecal matter w ELISA

1. Exocrine Insufficiency/
2. Chr. Pancreatitis/
3. Cancer