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Chronic Pancreatitis: Evaluation and Treatment

by Carlo Raj, MD
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    Evaluation of chronic pancreatitis. You’ll find this to be interesting. Serum amylase and lipase, I told you earlier if there’s such extensive damage taking place at the pancreas, that amylase and lipase become less reliable. So now what are you looking for? Watch this. Pancreatic function test. Before we go on, let me ask you a question. If it's digestion and you just had a lipid meal, what is the name of the hormone that’s being released from the duodenum? Good. From the Islet cells, you release CCK and that CCK will then contract the gallbladder, bringing in your bowel, but what kind of enzyme do you need to finish off the job in which the micelles get metabolized? Lipase. Next, pancreas, all this acid. Think about where you are right now. The pancreas, pancreatic duct, hooking up with the second part of the duodenum. All this acid, coming in with the chime from the stomach, don’t you need to neutralize that acid quickly? Sure, you do. And what's the of that substance that neutralizes it? Called bicarb. What’s the name of the hormone responsible for bicarb secretion? Secretin. Keep those in mind. Let’s take a look now. We have something called bentiromide test. Decreased urinary level suggests exocrine insufficiency. That, you’ll have to memorize, bentiromide. Then we have direct measurement of bicarb and enzyme concentration after CCK or secretin stimulation. CCK, normally responsible for stimulating or releasing what? Bicarb in the duodenum. But if you have chronic pancreatitis, that is not happening effectively or you have CCK. CCK normally responsible for releasing lipase into your duodenum and that is not occurring properly. Stool test. What are you looking for in there? If there is pancreatic damage, understand that there might be increased amount of fat in your stool, steatorrhea,...

    About the Lecture

    The lecture Chronic Pancreatitis: Evaluation and Treatment by Carlo Raj, MD is from the course Pancreatic and Biliary Tract Diseases.


    Included Quiz Questions

    1. Serum amylase and lipase levels
    2. Bentiromide test
    3. Direct stimulation of bicarbonate after stimulation with cholecystokinin and secretin
    4. CT of abdomen
    5. Fecal chymotrypsin levels
    1. Serum amylase and lipase - increased Plasma cholecystokinin - increased Fecal fat after 72 hours - increased Fecal chymotrypsin - Decreased
    2. Serum amylase and lipase - increased Plasma cholecystokinin - increased Fecal fat after 72 hours - increased Fecal chymotrypsin - Increased
    3. Serum amylase and lipase - increased Plasma cholecystokinin - increased Fecal fat after 72 hours - decreased Fecal chymotrypsin - Increased
    4. Serum amylase and lipase - increased Plasma cholecystokinin - Decreased Fecal fat after 72 hours - increased Fecal chymotrypsin - Decreased
    5. Serum amylase and lipase - Decreased Plasma cholecystokinin - increased Fecal fat after 72 hours - increased Fecal chymotrypsin - Decreased
    1. 4 cm and asymptomatic
    2. 8cm and asymptomatic
    3. 3cm and symptomatic
    4. 5cm and symptomatic
    5. 1 cm and symptomatic

    Author of lecture Chronic Pancreatitis: Evaluation and Treatment

     Carlo Raj, MD

    Carlo Raj, MD


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