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Flashcards in Wk 9 Deck (16)
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1

what's the imaging of choice for diagnosing acute pancreatitis?

CT (can note inflammation of gland)

2

what are the possible complications of acute pancreatitis?

necrotizing pancreatitis
fistula
pseudocyst
infxn
pulmonary: atelectasis, pleural effusion, pneumonia, ARDS
renal failure

3

which lab values are indicative of acute pancreatitis?

elev. serum amylase and lipase
elev. WBC count 12,000-20,000
elev. ESR, CRP
possibly hyperglycemia

4

how quickly and how long does serum amylase stay elevated?

rises 2-12 hrs after onset of acute pancreatitis
remains elev. for 3-5 days

5

what ND treatments are appropriate for acute pancreatitis?

-pancreatic rest (avoid solid food for 24 hrs, reintroduce fatty foods 3-6 days after light food is tolerated)
-fish oil once fatty foods are tolerated
-castor oil infused with Larrea tridentata (reduces inflammation)
-botanicals: belladonna, salvia miltorrhiza, calendula off., Yarnell's formula

6

what are the uses and limitations of fecal chymotrypsin and elastase-1 testing?

-fecal chymotrypsin- low levels may indicate pancreatic insuff. or hypochlorhydria. May be falsely elev. with supplementation of pancreatic enzymes.
-fecal elastase-1 testing-low levels (lower than 200 ug/g) indicate exocrine insufficiency, chronic pancreatitis, and cancer. Accurate even with pancreatic enzyme supplementation (makes it the test of choice)

7

what is the etiology of pancreatic insufficiency?

-overeating
-bad diet (low fiber,high sugar,excess CHO/EtOH, excess caffeine)
-lack of raw food in the diet
-def. of zinc, manganese, magnesium, protein, & Vit B6
-H. pylori, giardia, SIBO
-hypothyroidism, hypoadrenalism
-poor food hygiene
-Celiac dz
-cow milk enteropathy

8

what is the etiology for chronic pancreatitis?

-alcoholism (60-70%!!!)
-idiopathic
-obstruction of pancreatic duct

9

what is the gold standard for diagnosing chronic pancreatitis?

Abdominal X-ray or CT (if pancreatic calcification evident, dx is definitive)
*labs & imgaging can be normal

10

what is the classic triad for chronic pancreatitis?

DM
steatorrhea
pancreatic calcification
*usu presents late in dz

11

what are the dietary consideration in chronic pancreatitis?

-increase foods rich in Vit A, C, D, K, calcium, B12 & folic acid
-avoid all animal foods except fish
-incr fruits, vegetables, nuts, legume intake
-incr fluids
-incr olive oil, coconul oil, fish oil
-avoid spicy, salty, fatty, caffeine, sweets, tofu, shellfish
-*elimination of EtOH and tobacco

12

what therapies are useful for chronic pancreatitis?

-pancreatic enzymes (lipase!)
-fat soluble vitamins, Vit C, Mg & Se
-castor oil pack, vinegar pack, constitutional hydrotherapy, alt hot & cold to abdomen
-botanicals-Spasmolytic Herbs (Viburnum opulus, Dioscorea villosa, Valeriana off), Analgesic herbs (Belladonna, Gelsemium, Pulsatilla), Antifibrotic herbs (Centella asiatica, Silybum marianum, Scutellaria, Colchiicum)
-Homeopathics (Belladonna, Carbo animalis, Conium, Iodium..)

13

why is pancreatic cancer so often missed in diagnosis?

-onset of ssx are subtle and nonspecific...gradual (malaise, fatigue, nausea, anorexia, mid-epigastric/back pain)
-at Dx, 90% of pt's CA have mets

14

which two tumor markers are helpful in diagnosis of pancreatic cancer?

CA 19-9- major useful tumor marker bc highly specific for malignancy of pancrease but not good at early detection and not helpful for screening bc of low sensitivity
CEA- minimal utility in pancreatic carcinoma bc other benign and malignant conditions lead to elev. CEA levels

15

what are the primary means for prevention of pancreatic cancer?

smoking cessation
maintain a healthy weight, regular exercise, and healthy diet
stress management

16

what are the treatment options in pancreatic cancer?

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