Flashcards in Wk 9 Deck (16)
what's the imaging of choice for diagnosing acute pancreatitis?
CT (can note inflammation of gland)
what are the possible complications of acute pancreatitis?
pulmonary: atelectasis, pleural effusion, pneumonia, ARDS
which lab values are indicative of acute pancreatitis?
elev. serum amylase and lipase
elev. WBC count 12,000-20,000
elev. ESR, CRP
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
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
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)
what is the etiology of pancreatic insufficiency?
-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
-poor food hygiene
-cow milk enteropathy
what is the etiology for chronic pancreatitis?
-obstruction of pancreatic duct
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
what is the classic triad for chronic pancreatitis?
*usu presents late in dz
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 olive oil, coconul oil, fish oil
-avoid spicy, salty, fatty, caffeine, sweets, tofu, shellfish
-*elimination of EtOH and tobacco
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..)
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
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
what are the primary means for prevention of pancreatic cancer?
maintain a healthy weight, regular exercise, and healthy diet