What are the 2 key concepts in acute pancreatitis tx?
requires early and aggressive intravenous fluid resuscitation
Managed similarly to pts with sepsis
What sx are present in an inflammatory episode of acute pancreatitis?
intrapancreatic enzyme activation with pain
nausea and vomiting
What are the 5 causes of Acute Pancreatitis?
Gallstones (including microlithiasis)
Acute discontinuation of medications for diabetes or hyperlipidemia
Following endoscopic retrograde cholangiopancreatography (ERCP)
What meds can cause acute pancreatitis?
ACE, ARBS; thiazide diuretics, furosemide
Antimetabolites (mercaptopurine and azathioprine)
Corticosteroids; glyburide; exenatide (Byetta)
HMG-CoA reductase inhibitors, especially simvastatin
What are 4 possible mechanisms of drug-induced acute pancreatitis?
direct toxic effects of the drug or its metabolites
alterations of cellular function in the pancreas and pancreatic duct
What is the 1st line tx for acute pancreatitis?
Fluid resuscitation: isotonic crystalloid solution— NS or LR
Why is fluid resuscitation given in acute pancreatitis?
to reduce the risks of SIRS and organ failure
What should you do if vomiting persists past fluid resuscitation in acute pancreatitis?
NPO or NG tube
Fluid resuscitation can be ____________ or _________.
Fluid resuscitation can be enteral or parenteral.
Begin oral alimentation after pain, tenderness, and ileus have resolved: small amounts of high-carbohydrate, low-fat, and low-protein foods; advance as tolerated
What type of pancreatitis is this tx used for?
What should you advise pts with acute pancreatitis during discharge?
dietary modification to reduce dietary fats, alcohol, and added sugars
Long-standing and progressive destruction of pancreatic tissue due to persistent inflammation
Results in exocrine and/or endocrine insufficiency
Which type of pancreatitis?
What are the hallmark complications of Chronic Pancreatitis?
malabsorption with resultant steatorrhea
risk of pancreatic cancer
What are the primary treatments for malabsorption due to chronic pancreatitis?
pancreatic enzyme supplementation
reduction in dietary fat intake
Which drug can cause an increase in sphincter of Oddi pressure?
Why should you avoid Demerol in tx of acute pancreatitis?
porential of accumulation of a toxic metabolite normeperidine
What tx is no longer recommended for acute pancreatitis?
How do you tx pts with ascending cholangitis or necrotizing pancreatitis?
B-lactam/B-lactamase inhibitor: piperacillin/tazobactam can be considered for initial treatment before cultures (especially of aspirated collections) if a strong suspicion of active infection.
What do you tx acute pancreatitis with if pt has cholangitis and pt is allergic to penicillin?
What should you be vigilant for when giving prophylactic abx in acute pancreatitis?
What are the tx options for chronic pancreatitis?
enteric-coated pancreatic enzyme supplements
antisecretory agent + pancreatic enzyme supplementation
What can you add to enteric-coated pancreatic enzyme supplements to increase the effectiveness of enzyme therapy for malabsorption and steatorrhea found in chronic pancreatitis?
Histamine2-receptor antagonist or proton-pump inhibitor
What would adding an antisecretory agent to pancreatic enzyme supplementation help achieve?
may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea
What are possible chronic pancreatitis txs?
Analgesics: tramadol, chronic opioid, gabapentin, pregabalin, SNRIs or TCAs, traditional pancreatic enzyme supplements
Uncoated enzymes (Viokase)
Uncoated enzymes (Viokase) may be more efficacious for what sx when given with what other medication?
Uncoated enzymes (Viokase) may be more efficacious for pain control (when given with proton pump inhibitors [PPIs] to protect their integrity) compared with coated enzymes, but this strategy is controversial.
T/F: There is a theoretical benefit to using PPIs, even with coated enzymes, in patients with vitamin deficiency to allow faster release of enzymes into the proximal duodenum where fat-soluble vitamin absorption occurs
When would you treat pts with corticosteroids?
When should you administer pancreatic enzymes?
during or just after meals
T/F: Products containing enteric-coated microspheres or minimicrospheres may be less effective than other dose forms
False; Products containing enteric-coated microspheres or minimicrospheres may be more effective than other dose forms
Primarily used to treat malabsorption associated with chronic pancreatitis
also used to treat pain from the disease