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  #1  
Old 09-11-2011
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Default Q Git

A 55-year-old white woman has had recurrent episodes of alcohol-induced pancreatitis. Despite abstinence, the patient develops postprandial abdominal pain, bloating, weight loss despite good appetite, and bulky, foul-smelling stools. KUB shows pancreatic calcifications. In this patient, you should expect to find which of the following?

A)Malabsorption of fat-soluble vitamins D and K
B)Diabetes mellitus
C)Guaiac-positive stool
D)Courvoisier sign
E) Markedly elevated amylase
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Old 09-11-2011
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Default A

A. Chronic pancreatitis is associated with malabsoption. The patient could have high amylase, but not significant high amylase (D).
C is seen in ampuloma.
D is an enlarged gallbladder, commonly seen with assoc. neoplasia.
B is an endocr. defect of the pancreas, not exocrine!
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  #3  
Old 09-11-2011
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Quote:
Originally Posted by dr_mhm View Post
A. Chronic pancreatitis is associated with malabsoption. The patient could have high amylase, but not significant high amylase (D).
C is seen in ampuloma.
D is an enlarged gallbladder, commonly seen with assoc. neoplasia.
B is an endocr. defect of the pancreas, not exocrine!
in chronic pancreatitis, amylase n lipase levels r usually not elevated, plus the pts can present with loss of both exocrine n endocrine function of pancreas, which means they can present with steatorrhea as well as with DM.....
however in this scenario Ais the best choice...as he is having bulky stools...
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  #4  
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quoting from emedicine:

Chronic pancreatitis, demonstrated in the image below, is commonly defined as a continuing, chronic inflammatory process of the pancreas, characterized by irreversible morphological changes. This chronic inflammation can lead to chronic abdominal pain and/or impairment of endocrine and exocrine function of the pancreas. Chronic pancreatitis usually is envisioned as an atrophic fibrotic gland with dilated ducts and calcifications. However, findings on conventional diagnostic studies may be normal in the early stages of chronic pancreatitis, as the inflammatory changes can be seen only by histologic examination.

By definition, chronic pancreatitis is a completely different process from acute pancreatitis. In acute pancreatitis, the patient presents with acute and severe abdominal pain, nausea, and vomiting. The pancreas is acutely inflamed (neutrophils and edema), and the serum levels of pancreatic enzymes (amylase and lipase) are elevated. Full recovery is observed in most patients with acute pancreatitis, whereas in chronic pancreatitis, the primary process is a chronic, irreversible inflammation (monocyte and lymphocyte) that leads to fibrosis with calcification. The patient with chronic pancreatitis clinically presents with chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels; when the pancreas loses its endocrine and exocrine function, the patient presents with diabetes mellitus and steatorrhea.[1]
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  #5  
Old 09-11-2011
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A is most likely diagnosis
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  #6  
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Quote:
Originally Posted by aasiaafzal View Post
quoting from emedicine:

The patient with chronic pancreatitis clinically presents with chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels; when the pancreas loses its endocrine and exocrine function, the patient presents with diabetes mellitus and steatorrhea.[1] [/I]
The correct answer is B. Diabetes Mellitus

Chronic pancreatitis is caused by pancreatic damage from repeated attacks of acute pancreatitis. The classic triad is abdominal pain, malabsorption, and diabetes mellitus. Twenty-five percent of cases are idiopathic.
Vitamins D and K are absorbed intact from the intestine without digestion by lipase and are therefore absorbed normally in pancreatic insufficiency. Forty percent of patients, however, develop B12 deficiency. Treatment of the malabsorption with pancreatic enzyme replacement will lead to weight gain, but the pain can be difficult to treat.
Courvoisier sign is a palpable, nontender gall-bladder in a jaundiced patient. This finding suggests the presence of a malignancy, usually pancreatic cancer.
Chronic pancreatitis per se does not produce guaiac-positive stools.
Amylase is usually normal in patients with chronic pancreatitis.

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  #7  
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Quote:
Originally Posted by step1an View Post
The correct answer is B. Diabetes Mellitus

Chronic pancreatitis is caused by pancreatic damage from repeated attacks of acute pancreatitis. The classic triad is abdominal pain, malabsorption, and diabetes mellitus. Twenty-five percent of cases are idiopathic.
Vitamins D and K are absorbed intact from the intestine without digestion by lipase and are therefore absorbed normally in pancreatic insufficiency. Forty percent of patients, however, develop B12 deficiency. Treatment of the malabsorption with pancreatic enzyme replacement will lead to weight gain, but the pain can be difficult to treat.
Courvoisier sign is a palpable, nontender gall-bladder in a jaundiced patient. This finding suggests the presence of a malignancy, usually pancreatic cancer.
Chronic pancreatitis per se does not produce guaiac-positive stools.
Amylase is usually normal in patients with chronic pancreatitis.

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wow..!!
even this close to the exam, luks like im learning the basics...!!! uggghh

i thought vit A,D,E,K being fat soluble would b affected with deficient lipase n amylase...
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  #8  
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hey step1an,,

can u explain y not vit A,D,E,K n why b12??
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  #9  
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I think we need pancreatic lipase to separate intrinsic factor from vit. B12 before it can be aborbsed through the intestine. As exocrine function of pancrease is decreased in chronic pancreatitis, so patients can get vit. B12 deficiency.
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  #10  
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Quote:
Originally Posted by step1an View Post
I think we need pancreatic lipase to separate intrinsic factor from vit. B12 before it can be aborbsed through the intestine. As exocrine function of pancrease is decreased in chronic pancreatitis, so patients can get vit. B12 deficiency.

hmm right..!!
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