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Flashcards in Pancreatitis Deck (31):
1

Acute pancreatitis Tx requires

early and aggressive IVF resuscitation, management similar to sepsis

2

Sx of acute pancreatitis are related to

activation of enzymes in the pancreas 2/2 pain, n/v, and intestinal ileus

3

Etiology of acute pancreatitis is

Alcohol
gall stones
trauma, surgery
acute d/c of diabetes or HLD drugs
s/p endoscopic retrograde cholangiopancreatography

4

MC meds that cause pancreatitis are

ACE, ARB, Thiazide diuretics, Furosemide
Azathioprine
Corticosteroids
Glyburide
Mesalamine
Bactrim
Valproic acid
Statins (esp. Simvastatin)

5

The meds that cause acute pancreatitis do so 2/2

direct toxic effects of the drug or it's metabolites
hypersensitivity
drug induced hypertriglyceridemia
alterations of cellular function in pancreas/pancreatic duct

6

Analgesics used to Tx acute pancreatitis are

Hydromorphone
Fentanyl
Morphine (but can increase pressure in sphincter of oddi)
AVOID: demerol! normeperidine (metabolite) can accumulate and become toxic

7

Does acute pancreatitis require antibiotics and if so, which

Prophylaxis no longer recommended
Ascending cholangitis or necrotizing pancreatitis: Piperacillin-Tazobactam
Cholangitis allergic to penicillin: Levofloxacin

8

Does acute pancreatitis require fluids

Yes! Isotonic crystalloid solution, NS or LR to reduce risk of persistent SIRS and organ failure

9

Other acute pancreatitis Tx are

Enteral or parenteral nutrition
Can start oral alimentation after pain subsides and ileus has resolved (small amounts of high carb, low fat/protein)
NPO or NG if vomiting persists
Dc w/: diet modification (reduce fat, alcohol, added sugar)

10

Algorithm for acute pancreatitis says start with

screen for SIRS
Fluid replacement w/ LR
correct lytes
treat metabolic abn
pain control
assess meds and contributing factors
consider ERCP if cholangitis or biliary pancreatitis

11

Algorithm for acute pancreatitis says step 2 based on severity is

Mild: PO food when pain decreases and labs improve
mod: +/- ICU, Tx systemic complications, Gradual diet advance
Severe: ICU. Tx systemis Sx, Enteral tube feed. If no improvement and you r/o pancreatic necrosis, Tx w/ abx

12

Hallmark complications of chronic pancreatitis are

Chronic pain
malabsorption w/ steatorrhea
DM
Pancreatic cancer

13

Primary treatments for malabsorption 2/2 chronic pancreatitis are

Pancreatic enzyme supplement (enteric coated)
Reduce dietary fat intake

14

What can be added to pancreatic enzyme supplement for choronic pancreatitis

Antisecretory agent to increase effect on malabsorption and steatorrhea
H2 blocker or PPI

15

What analgesics can be used in treating chronic pancreatitis

Tramadol (first line)
Chronic opioid (morphine, fentanyl)
Gabapentin, pregabalin, SNRI, TCA (adjunct)
(pancreatic enzymes can also be used to Tx pain form the diseasE)

16

Should you take coated or non-coated enzymes

Uncoated (Viokase) are more effective in pain control when given w/ a PPI, but are controversial

17

What IV drug is beneficial therapy for pancreatic ductal fistulae

Octreotide

18

What can you take for autoimmune pancreatitis

Individualized dose of corticosteroids

19

In order to treat malabsorption and steatorrhea, how should you take pancreatic enzymes

Start at 25-40K USP Lipase with each meal
Admin dose during or just after meal
Max dose is 75K
Enteric coated microsphere products may be more effective

20

Why do pancreatic enzymes provide pain relief

They can break down CCK
(normally, CCK causes an increase in pancreatic secretion but can be inhibited by Trypsin)

21

Patients with chronic pancreatitis show a decrease in

Trypsin production- which normally inhibits the release of CCK
When CCK is released, pain increases 2/2 unabated pancreatic secretion

22

Proteases in pancreatic supplements act as

substitutes for endogenous trypsin= decrease in CCK

23

Available pancreatic enzymes are

Creon (enteric coated minimicrospheres)
Pancreaze and Ultresa (enteric coated minitabs/microtabs)

24

What is celiac disease

AI immune mediated response to gluten
Sensitivity to Gliadin fraction in glutens
Tissue transglutaminase modified proteins (not sure what she is saying about these)
Immunologic cross reactivity, inflammation, and tissue damage cause malabsorption

25

Mnemonic for celiac disease Tx is (CELIAC)

Consultation w/ dietician
Education about dz
Lifelong gluten free adherence
Identify and treat ntr deficiency
Access to advocacy group
Continuous long term f/u

26

Overlooked sources of gluten are

Oral Rx drugs
Non-Rx drugs
vitamins and minerals
health and beauty aids

27

What are safe foods to eat

Rice
Corn
Soybean flour
Uncontaminated oats
Tapioca
Quinoa
Amaranth
Sorghum

28

What Ig normalizes when you remove gluten

IgA!

29

In refractory celiac reports, treat with

Steroids
Azathioprine (caution, leads to lymphoma)
Cyclosporine
Tacrolimus
Infliximab, Alemtuzumab

30

What nutrients do you need to sub in celiac

A, D, E, B12
Calcium
Carotene
copper
zinc
folic acid
ferritin
iron

31

Celiac disease is associated with

hyposplenism; give pneumovac!!