Pancreatitis:
- The early stage has a systemic inflammatory response (SIRS) or organ damage. Late associated with local complications.
- Signs:
- Abdominal pain, nausea and vomiting, jaundice, fever
- Local complications: necrosis, hemorrhage, pseudocyst, abscess, infection
- Systemic complications: SIRs, acute respiratory distress, shock, organ failure
- Causes:
- Alcohol, gallstones, drugs (azathioprine, adenosine, diuretics, estrogens, exenatide, mesalamine, pentamidine, sitagliptin, tetracycline, Bactrim, valproic acid), hypertriglyceridemia, toxins, trauma and ischemia
- M-ANNHEIM risk factors:
- M- multiple risk factors
- A-alcohol
- N-Nicotine
- N-Nutrition
- H-Heredity
- E-Efferent duct
- I-Immunological
- M-Misc
- Treatment:
- Acute:
- Treatment is largely supportive. Withhold oral intake, give IV fluids (lactated ringers usually), treat electrolytes, treat pain (no meperidine), IV ondansetron, promethazine or prochlorperazine.
- Can resume oral feeding when no N&V. Avoid TPN
- No antibiotics
- Chronic
- Abstinence from alcohol is essential. Need non-narcotic and narcotic analgesia, but avoid APAP.
- May need to supplement with pancreatic enzymes and change eating pattern to frequent, low-fat meals and fat-soluble vitamin supplementation. Give enzymes before or during meal. Titrate to weight gain.
- Acute:
Irritable Bowel Syndrome:
There are three types of IBS, and most real-world cases are mixed.
| Constipation: Fiber osmotic laxatives 5-HT4 Agonists (metoclopramide) Cl Channel Activators (lubiprostone) Guanylate cyclase agonist Use stool softener and laxative first | Diarrhea: Antidiarrheals first Cholestyramine 5-HT3 antagonists (alosetron) | Pain/Gas/Bloating: anticholinergics antidepressants psychological treatment |
Some notes:
- lubiprostone is used in women with IBS
- alosetron is for diarrhea-predominant IBS
- tegaserod is for constipation induced IBS, it’s restricted due to cardiovascular side effects
- linaclotide – constipation predominant IBS