Wk 9

Question 1

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

Answer 1

CT (can note inflammation of gland)

Question 2

what are the possible complications of acute pancreatitis?

Answer 2

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

Question 3

which lab values are indicative of acute pancreatitis?

Answer 3

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

Question 4

how quickly and how long does serum amylase stay elevated?

Answer 4

rises 2-12 hrs after onset of acute pancreatitis

remains elev. for 3-5 days

Question 5

what ND treatments are appropriate for acute pancreatitis?

Answer 5

• 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

Question 6

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

Answer 6

• 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)

Question 7

what is the etiology of pancreatic insufficiency?

Answer 7

• 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

Question 8

what is the etiology for chronic pancreatitis?

Answer 8

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

Question 9

what is the gold standard for diagnosing chronic pancreatitis?

Answer 9

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

Question 10

what is the classic triad for chronic pancreatitis?

Answer 10

DM
steatorrhea
pancreatic calcification
*usu presents late in dz

Question 11

what are the dietary consideration in chronic pancreatitis?

Answer 11

• 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

Question 12

what therapies are useful for chronic pancreatitis?

Answer 12

• 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..)

Question 13

why is pancreatic cancer so often missed in diagnosis?

Answer 13

• 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

Question 14

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

Answer 14

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

Question 15

what are the primary means for prevention of pancreatic cancer?

Answer 15

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

Question 16

what are the treatment options in pancreatic cancer?

Answer 16

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