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Flashcards in Wk 9 Deck (16)
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what's the imaging of choice for diagnosing acute pancreatitis?

CT (can note inflammation of gland)


what are the possible complications of acute pancreatitis?

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


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


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
-hypothyroidism, hypoadrenalism
-poor food hygiene
-Celiac dz
-cow milk enteropathy


what is the etiology for chronic pancreatitis?

-alcoholism (60-70%!!!)
-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?

pancreatic calcification
*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 fluids
-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?

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


what are the treatment options in pancreatic cancer?

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