Chapter 23. Pancreatitis
Which combination of signs/symptoms is commonly associated with chronic pancreatitis (CP)?
A. Abdominal pain, fatty stools, glucose intolerance
B. Abdominal pain, elevated amylase and lipase, encephalopathy
C. Abdominal pain, coffee ground emesis, melena
D. Fever, tachycardia, hypotension
Option A: Correct. The common triad of chronic pancreatitis (CP) is abdominal pain, fatty stools (exocrine dysfunction), and glucose intolerance (endocrine dysfunction).
Option B: Incorrect. Patients often present with abdominal pain; however, the amylase and lipase can be normal in patients with CP, and encephalopathy should not be present. Alternative diagnoses should be evaluated in patients with encephalopathy.
Option C: Incorrect. Patients with CP do not commonly present with signs of an upper GI bleed (coffee-ground emesis, melena). Pseudoaneurysms may present with GI bleeding, but this is a rare complication of CP.
Option D: Incorrect. Fever, tachycardia and hypotension are most commonly seen with acute pancreatitis rather than CP.
Which statement best describes the pathophysiology of chronic pancreatitis (CP)?
A. Pancreatic atrophy is due to uncontrolled type 2 diabetes mellitus
B. CP is exacerbated when patients ingest a diet high in carbohydrates
C. CP is an inflammatory process leading to endocrine and exocrine dysfunction secondary to diffuse scaring and fibrosis
D. CP is most often caused by acute gallstones that obstruct the ampulla of Vater
Option A: Incorrect. CP may result in pancreatic atrophy that leads to glucose intolerance and may progress to diabetes; however, type 2 diabetes does not lead to CP.
Option B: Incorrect. Diets high in fat, not carbohydrates, may cause acute exacerbations of pain in patients with CP.
Option C: Correct. CP is a chronic inflammatory process leading to endocrine and exocrine dysfunction over time.
Option D: Incorrect. Acute gallstones are a common cause of acute pancreatitis. Recurrent episodes of acute pancreatitis can lead to CP; however, an acute gallstone does not cause CP.
Which of the following are risk factors for chronic pancreatitis?
B. Hypertension, enalapril use
C. Ethanol, tobacco, enalapril use
D. Diabetes, tobacco use, hypertension