1) A patient presents to the ED with intense left upper abdominal pain, nausea, and vomiting. Before proceeding with testing, it is most important to rule out:
A. Irritable Bowel Syndrome
B. Peptic Ulcer Disease
C. Myocardial Infarction
D. Autoimmune Pancreatitis
Answer: C
Rationale: A myocardial infarction is the most serious potential problem this patient could be experiencing, despite the lack of more “hallmark” MI symptoms. IBS, PUD, and autoimmune pancreatitis all require a combination of lab work and imaging, and are not immediately life threatening.
2) Management of pancreatitis includes adjustment of certain lifestyle factors. When educating your patient on how to minimize their symptoms, which change is most important for this patient with pancreatitis?
A. Making sure they exercise at least 30 minutes 5 times per week
B. Drinking at least 2 L of water per day to flush out the pancreatic enzymes
C. Eating 5-6 small meals per day instead of three, to help the pancreas keep up with digestion
D. Encourage them to eat a diet that is high in fat, but low in protein and carbohydrates
Answer: C
Rationale: Eating smaller quantities of food, and thus keeping the workload for the digestion system lower is a good way for patients to reduce symptoms of pancreatitis. Larger workload for the pancreas may increase the back flow of pancreatic enzymes, increasing the inflammation within the organ. While option A and B are good suggestions for general health, they aren’t as important as adjusting meal size with pancreatitis. Option D is incorrect because we want patients to eat a diet that is LOW in fat, and HIGH in protein and carbohydrates with pancreatitis.
3) Which of the following is NOT a function of the hormone secreting Islets of Langerhans?
A. Glucagon stimulation to initiate glyconeogenesis
B. Secretion of pancreatic polypeptide to stimulate gastric secretions aiding in digestion
C. Insulin secretion to promote glucose utilization and storage
D. Release of alkaline fluids into the pancreatic duct to aid in digestion
Answer: D
Rationale: The Islets of Langerhans are a part of the endocrine pancreas, and include Alpha cells, Beta cells, Delta cells, and F cells. Option A describes the function of Alpha cells; option B describes the function of F cells; option C describes the function of Beta cells; option D describes a function of the exocrine pancreas.
4) Your patient has been diagnosed with pancreatitis. You explain to them that they are getting a CT scan to help determine whether there is chronic damage. Which is an accurate statement regarding chronic pancreatitis?
A. The presence of fibrosis, strictures, and/or atrophy seen in chronic pancreatitis are what differentiate it from acute pancreatitis
B. Chronic episodes of pancreatitis are usually mild and resolve on their own
C. If someone has chronic pancreatitis, this inflammation has been present since birth
D. Chronic pancreatitis is immediately life-threatening
Answer: A
Rationale: Late chronic pancreatitis often manifests as loss of pancreatic tissue (atrophy). Option B is describing an acute episode of pancreatitis as opposed to chronic. While it is not impossible that chronic pancreatitis would have been present since birth, it is more likely that it developed over the course of one’s life (as smoking and alcohol use are contributing factors in many cases of chronic calcifying pancreatitis). It is important for chronic pancreatitis to be treated appropriately, but it is not immediately life threatening like severe acute pancreatitis can be.
5) Which of the following lab values would be indicative of a patient experiencing acute pancreatitis?
A. serum alanine aminotransferase enzyme level of 175 U/L
B. three-fold increase of serum lipase
C. three-fold increase of serum amylase
D. all of the above
Answer: D
Rationale: all of these serum levels are tested in identifying pancreatitis. In pancreatitis, it is common to expect serum lipase and amylase levels to be three-fold higher than normal, and for serum alanine aminotransferase enzyme levels to be greater than 150 U/L.