Question 1
What is FALSE regarding the management of feeding in patients with pancreatitis
(A) Patients with mild pancreatitis often do NOT require a feeding regime
(B) Patients with severe pancreatitis should have total parental nutrition compared to enteral nutrition to rest the bowel and decrease pancreatic stimulation
(C) Parenteral nutrition should be instituted within 24 hours of a diagnosis of severe acute pancreatitis
(D) Enteral nutrition should be instituted within 48 hours of a diagnosis of severe acute pancreatitis
(E) Total parenteral nutrition should be instituted 48 hours after the diagnosis of severe acute pancreatitis
C and E: Often mild pancreatitis resolves without the requirement of fasting. Severe acute pancreatitis should be managed with bowel rest, aggressive hydration and infection if complicated with pancreatic necrosis (CT scan on day 5 of admission should be done, not earlier as it will fail to show progress to infective necrosis). Enteral nutrition is preferred over TPN. Enteral nutrition is associated with reduced infective complications, reduced length of stay and a tendency towards improved mortality. Total parental nutrition is associated with increased infective complications Med J Aust 2015; 202 (8): 420-423.
Question 2:
A 45 year old male with a history of alcohol dependence has recurrent epigastric pain. This time he presents to the ED and is admitted under the gastroenterology team. An abdominal x-ray confirms calcification in the pancreas. Which one of the following would you give for symptomatic relief?
(A) creon
(B) opiates
(C) coeliac plexus block
(D) dietary supplements
(E) distal pancreatectomy
B: Creon with PPI is used to treat steatorrhoea.
Question 3:
Which of the following is NOT a manifestation of short bowel syndrome?
(A) hyperoxaluria
(B) hypocalcaemia
(C) bloody diarrhoea
(D) megaloblastic anaemia
(E) ecchymoses
C: hyperoxaluria occurs because of impaired fatty acid absorption meaning that Ca-fatty acid complexes are washed away in the gut leaving oxalate free to be absorbed. Hypocalcaemia occurs because of decreased vitamin D absorption as well as dietary calcium absorption. Megaloblastic anaemia is due to decreased B12 and folate, and often the picture can be mixed with iron deficiency. Ecchymoses can occur as a result of vitamin K deficiency and resultant coagulopathy Gastroenterology 1997; 113:1767
Question 4:
Which of the following treatments has shown benefit for preventing post ERCP related pancreatitis?
(A) Rectal indomethecin
(B) Heparin
(C) Steroids
(D) IL-10
(E) Paracetamol-Codeine
A: " one dose of rectal indomethacin given immediately after ERCP significantly reduced the incidence of post-ERCP pancreatitis in patients at elevated risk for this complication. Moreover, we found that prophylactic indomethacin decreased the severity of post-ERCP pancreatitis and was associated with a shorter hospital stay. In this trial, the number of high-risk ERCP patients who would need to be treated to prevent one episode of pancreatitis was 13." - this statement applies especially to those who have Sphincter of Odi dysfunction. N Engl J Med 2012; 366:1414-1422
What is FALSE regarding the management of feeding in patients with pancreatitis
(A) Patients with mild pancreatitis often do NOT require a feeding regime
(B) Patients with severe pancreatitis should have total parental nutrition compared to enteral nutrition to rest the bowel and decrease pancreatic stimulation
(C) Parenteral nutrition should be instituted within 24 hours of a diagnosis of severe acute pancreatitis
(D) Enteral nutrition should be instituted within 48 hours of a diagnosis of severe acute pancreatitis
(E) Total parenteral nutrition should be instituted 48 hours after the diagnosis of severe acute pancreatitis
C and E: Often mild pancreatitis resolves without the requirement of fasting. Severe acute pancreatitis should be managed with bowel rest, aggressive hydration and infection if complicated with pancreatic necrosis (CT scan on day 5 of admission should be done, not earlier as it will fail to show progress to infective necrosis). Enteral nutrition is preferred over TPN. Enteral nutrition is associated with reduced infective complications, reduced length of stay and a tendency towards improved mortality. Total parental nutrition is associated with increased infective complications Med J Aust 2015; 202 (8): 420-423.
Question 2:
A 45 year old male with a history of alcohol dependence has recurrent epigastric pain. This time he presents to the ED and is admitted under the gastroenterology team. An abdominal x-ray confirms calcification in the pancreas. Which one of the following would you give for symptomatic relief?
(A) creon
(B) opiates
(C) coeliac plexus block
(D) dietary supplements
(E) distal pancreatectomy
B: Creon with PPI is used to treat steatorrhoea.
Question 3:
Which of the following is NOT a manifestation of short bowel syndrome?
(A) hyperoxaluria
(B) hypocalcaemia
(C) bloody diarrhoea
(D) megaloblastic anaemia
(E) ecchymoses
C: hyperoxaluria occurs because of impaired fatty acid absorption meaning that Ca-fatty acid complexes are washed away in the gut leaving oxalate free to be absorbed. Hypocalcaemia occurs because of decreased vitamin D absorption as well as dietary calcium absorption. Megaloblastic anaemia is due to decreased B12 and folate, and often the picture can be mixed with iron deficiency. Ecchymoses can occur as a result of vitamin K deficiency and resultant coagulopathy Gastroenterology 1997; 113:1767
Question 4:
Which of the following treatments has shown benefit for preventing post ERCP related pancreatitis?
(A) Rectal indomethecin
(B) Heparin
(C) Steroids
(D) IL-10
(E) Paracetamol-Codeine
A: " one dose of rectal indomethacin given immediately after ERCP significantly reduced the incidence of post-ERCP pancreatitis in patients at elevated risk for this complication. Moreover, we found that prophylactic indomethacin decreased the severity of post-ERCP pancreatitis and was associated with a shorter hospital stay. In this trial, the number of high-risk ERCP patients who would need to be treated to prevent one episode of pancreatitis was 13." - this statement applies especially to those who have Sphincter of Odi dysfunction. N Engl J Med 2012; 366:1414-1422
