Pancreatitis, Diverticulitis

Question 1

What happens in pancreatitis?

Answer 1

Early activation of enzymes inside the pancreas causing auto digestion
-etiology: alcohol, gall stones, acutely stopping of hyperlipdemia and diabetes medications

Question 2

Which meds can cause pancreatitis?

Answer 2

• ACE-I
• simvastatin HMG-CoA reductase
• steroids
• TMP-SMX

Question 3

How do you treat pain in pancreatitis?

Answer 3

Hydromorphone
Fentanyl
Morphine
DONT USE MEPERIDINE

Question 4

Which abx do you use to tx pancreatitis?

Answer 4

• don’t use as prophylaxis
• for cholangitis or necrotizing pancreatitis use Beta-lactam inhibitor: Pip/Tazo
• use levofloxacin for those who have a penicillin allergy
• monitor for fungal infections

Question 5

Which fluid resuscitation is given in pancreatitis?

Answer 5

NS or LR

Question 6

Which diet modification are made for pancreatitis?

Answer 6

• NPO
• oral intake only after pain has resolved
• on discharge give reduce fat, eliminate alcohol and don’t eat sugars

Question 7

What is chronic pancreatitis

Answer 7

progressive destruction of pancreas from exocrine and endocrine function

Question 8

What are hallmark signs of chronic pancreatitis?

Answer 8

steatorrhea
DM
pancreatic cancer

Question 9

How do you treat pancreatic malabsoprtion?

Answer 9

enzymes

reduce fat intake

Question 10

T/F Pancreatic enzymes treat pain and malabsorption

Answer 10

True
* pain is caused by the inability to breakdown CCK , enzyme supplements provide trypsin which can break down and resolve the pain

Question 11

What is recommended dosage of enzymes for pancreatitis?

Answer 11

50,000-75,000 IU before each meal

• enteric coated enzymes used
• addition of PPI and

Question 12

What do pancreatic enzymes contain?

Answer 12

amylase
lipase
protease

Question 13

What analgesics are used for chronic pancreatitis?

Answer 13

Tramadol-first line

• morphine
• Gabapentin, pregabalin, SNRI’s ,TCA adjunctive therapy

Question 14

What do you give for autoimmune pancreatitis?

Answer 14

corticosteroids

Question 15

If a pancreatic fistula exist what can you give?

Answer 15

Octreotide- sub Q or IV

Question 16

What is Celiac’s disease?

Answer 16

immune mediated rxn to wheat gluten, rhye

Question 17

What does celiac’ disease affect?

Answer 17

small intestine
gene associated with celiacs: HLA-DQ2/DQ8
will test positive for IgA tTG

Question 18

What are some overlooked sources of celiac’s disease?

Answer 18

Oral rx drugs
non-prescrition drugs
vitamin and herbal supplements

Question 19

How do you tx celiac’s disease?

Answer 19

1. remove gluten fro diet
   2.give A,D,E, B12, and K vitamins
2. Pneumococcal vaccination: celiac’s is associated with hyposplenism
   4 Refractory cases: give Steroids, cyclosporine, infliximab

Question 20

What are signs of acute diverticulitis?

Answer 20

LLQ pain
leukocytosis
NO peritoneal signs

Question 21

How do you treat uncomplicated diverticulitis?

Answer 21

1. Add fiber/bulking agents >30grams/day
2. Abx: metronidazole and cipro/levo 7-10 days
   alternate: TMP-SMX and metronidazole
   2nd line: Augmentin or Moxifloxacin an metronidazole