Pancreatitis, GERD, and Peptic Ulcer Disease Flashcards
(33 cards)
Causes of Acute Pancreatitis
- Gallstones
- Alcohol
- High triglycerides
Acute Pancreatitis Signs and Symptoms
- Severe abdominal pain
- Elevated pancreatic enzymes in blood
- Self limiting
- Will spontaneously resolve in most patients
Management of Acute Pancreatitis
- Pain relief
- Fluid replacement
- Prevention of complications
Pain Management in Acute Pancreatitis
- Treat pain IV then PO
1) Morphine - Concerns with use do to spasm of sphincter of Oddi
- This concern has never been proven (i.e. Morphine is safe/effective)
2) Meperidine - Not as effective
- Active metabolites can accumulate
- Risk of seizure (due to metabolites)
Fluid Management in Acute Pancreatitis
- Hemoconcentration associated with organ failure and pancreatic necrosis
- Treat with normal saline
Preventing complications in Acute Pancreatitis
- Electrolyte balance
- Hyperglycemia can increase the risk of infections
- Infection is a large concern
Treating Infections in Acute Pancreatitis
- Do NOT use antibiotics for prophylaxis
- Determine that the patient does have an infection before beginning antibiotic therapy
- If there is an infection treat patient with
a) 500mg imipenem-cilastin q8h
b) Ciprofloxacin and metronidazole (if pt has a penicillin allergy)
Chronic Pancreatitis Patho
- Chronic state
- Results in functional and structural damage to pancreas
- Often undiagnosed for many years
- Alcohol consumption = big risk factor
Sings and symptoms of Chronic Pancreatitis
- Loss of pancreatic exocrine function
- Malnutrition
- Weight loss
- Diabetes Mellitus
Chronic Pancreatitis Treatment Goals
- Control pain
- Correct malabsorption
- Assess need for exogenous insulin
Pain Management in Chronic Pancreatitis
- Stop alcohol and tobacco use
- Eat small, low fat meals
- NSAIDs, Tylenol, or Tramadol
- Add on narcotic if pain persists
Correcting malabsorption in Chronic Pancreatitis
-Start exogenous enzyme supplementation
a) Acid Suppressive therapy- to increase stomach pH
(H2 antagonists or PPIs)
-Reduce dietary fat to <20g/meal
-Supplement with lipase, amylase, protease
-Lipase is most important one (30,000 to 90,000 units per meal)
-Take pancreatic enzymes with first bite of meal
Examples of pancreatic enzymes
- Creon
- Pancreaze
- Pancrelipase
- Pertzye
- Ultresa
- Viokace
- Zenpep
GERD Treatment
1) Weight loss and Dietary modifications
2) Antacids
3) Surface agents and alginates (Sucralfate)
4) H2 blockers
5) PPIs
Antacids
- Acts as on demand symptom relief for mild GERD
- Pro: fast onset
- Con: short duration
Surface Agents
- Used in mild cases
- And in pregnancy
- Viscous gum that coats and protects stomach
H2 Antagonists/Blockers
- More effective than antacids
- Pro: longer duration of action
- Con: longer onset, becomes less effective in subsequent dosing
Proton Pump Inhibitors (PPI)
- Most effective in treating GERD
- Pro: short onset
- Con: more expensive, drug interactions
Peptic Ulcer Disease Patho (PUD)
- Ulcers due to H. pylori infection, NSAID use, or stress
- Contributing factors: smoking and drinking
Types of Ulcers in PUD
a) Gastric- caused by NSAIDs or H. pylori,
- Usually WORSE with food
b) Duodenal- mostly caused by H. pylori can be caused by NSAIDs
- Usually gets BETTER with food
c) Complications include bleeding, obstruction, or perforation (ulceration into cavity) erosion of ulcer into artery (non-variceal bleed)
- Non variceal bleed can be insidious and fatal!
Diagnosis of H. pylori
- Breath test
- Stool antigen test
- PPIs, bismuth, and antibiotics can interfere with stool and breath test
- Endoscopy (scope): often used for H. pylori and to rule out other GI issues
Treatment of H. pylori
a) 3 drug regimen
- PPI bid (or esomeprazole 40mg qd)
- Clarithromycin 500mg bid
- Amoxicillin 1g bid (substitute with metronidazole 500mg bid if pt has a PCN allergy)
b) 4 drug regimen
- PPI bid (or esomeprazole 40mg qd)
- Bismuth 525mg qid
- Metronidazole 250 to 500mg qid
- tetracycline 500mg qid
c) If pt cannot tolerate PPI give H2 blocker instead
Pylera
-Pylera has bismuth, metronidazole, and tetracycline in it!
NSAID Induced Ulcers
- Highest risk with piroxicam and ketorlac
- Moderate risk with naproxen
- Lowest risk with ibuprofen and diclofenac
