Question

Gastroenterology Case Study QUESTIONS study. Acute and Chronic Pancreatitis: Review Questions Douglas G. Adler, MD Todd H. Raron, MD, FACP incidentally reveals cm pancreatie Choose the single best answer for each question pseudocyst near the tail of the pancreas that Questions 1 and 2 refer to the following case does not appear to communicate with the pancreatie duct. The patient has had successive attacks of mute pancreatitis over the past 2 A 49-year-old woman has a 24-hour history of years, the most recent occurring months ago nausea, vomiting, escalating epigastric pain radiating to from and has recovered each attack with her back, and fever (temperature to 101.3 F). Medical conservative measures. He no longer consumes history is remarkable for depression, cholecystectomy alcohol and currently feels well. Which of the (because of gallstones) 5 months ago, following is the most appropriate next step in and appendectomy during childhood. She takes fluoxetine managing this patient's pancreatitis? 20 mg daily for depression. Physical examination reveals a tender epigastrium as well as tenderness in the A) Observation right upper quadrant. Laboratory studies reveal the B) Endoscopic drainage of the cyst following serum levels: amylase, 14.500 U/L; lipase, C) Percutaneous drainage of the cyst 9300 U/L; aspartate aminotransferase, 500 U/L, alanine D) Surgical drainage of the cyst aminotransferase, 449 U/L; alkaline phosphatase, 420 E) Distal pancreatectomy with cyst removal U/L; total bilirubin, 1.9 mg/dl, calcium, 9.7 mg/dl; triglycerides, 430 mg/dL and leukocyte count, 16 4. A 62-year-old man with knows chronic pancreatitis caused by alcoholism reports a 20- pound weight loss over the past 3 months and 1. Which of the following is the most likely cause of frequent, greasy, and malodorous stools. A 72- this patient's pancreatitis? hour fecal fat collection confirms steatorrhea A) Alcohol abuse The patient no longer consumes alcohol and B) Fluoxetine administration reports no abdominal pain. Which of the C) Gallstones following is the most appropriate first-line D) Hypercalcemia treatment for this patient? E) Hypertriglyceridemia A) Administration of enterie-coated 2. Which of the following diagnostic tests is most pancreaticenzyme replacement tablets with appropriate to determine if gallstones are the meals and snacks and concurrent use of cause of the patient's pancreatitis? calciumcontaining antacids B) Administration of non enterie-coated pancre. A) Endoscopic retrograde cholangiopancreatog- atic enzyme replacement tablets with meals and raphy snacks B) Contrast-enhanced computed tomographic with concurrent dosing with a histamine, blocker (CT) scan of the abdomen C) Endoscopic placement of a pancreatic duct C) Percutaneous cholangiogram stent D) Plain radiographs of the abdomen D) Institution of a low-fat diet (less than 20 E) Ultrasonography of the right upper quadrant E) Subcutaneous administration of octreotide 3. A contrast-enhanced CT scan of the abdomen in 200 ug 3 times daily a 51-year-old man with a history of alcohol abuse confirms the presence of renal calculi and 10/mm' gfat/day)

Answer 1

1. Fluoxetine administration increases risk of acute pancreatitis

2. Ct scan of abdomen may provide information about severity of pancreatitis and also tell if gallstones stuck in pancreas.

3.observation as pseudocyst is not dangerous untill it ruptures.

4. B. Administration of non enteric coated pancreatic enzyme replacement therapy withmeals and concurrent use of histamine blocker as that will suppress acid production and increase effectiveness of enzyme replacement therapy