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ACUTE PANCREATITIS

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  • Image not available. Patients with severe acute pancreatitis require early and aggressive intravenous fluid resuscitation and should be managed similarly to patients with sepsis.
  • Image not available. Factors that can contribute to acute pancreatitis should be corrected, including discontinuation of medications that could be potential causes.
  • Image not available. Parenteral opioid analgesics are used to control abdominal pain associated with acute pancreatitis.
  • Image not available.Meperidine is not recommended as a first-line agent for the treatment of pain from acute pancreatitis due to the risk of adverse effects and the resultant dosing limitations.
  • Image not available. The only definitive indication for antibiotic use in acute pancreatitis is to treat known or suspected infection.

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CHRONIC PANCREATITIS

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  • Image not available.Chronic pain, malabsorption with resultant steatorrhea, and diabetes mellitus are the hallmark complications and symptoms of chronic pancreatitis.
  • Image not available. Pain from chronic pancreatitis can initially be treated with nonopioid analgesics, but opioids will eventually be required as the disease progresses.
  • Image not available. Pancreatic enzyme supplementation and reduction in dietary fat intake are the primary treatments for malabsorption due to chronic pancreatitis.
  • Image not available. Enteric-coated pancreatic enzyme supplements are the preferred dosage form in the treatment of malabsorption and steatorrhea due to chronic pancreatitis.
  • Image not available. The addition of an antisecretory agent to pancreatic enzyme supplementation may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea due to chronic pancreatitis.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the epidemiology, etiology, and prognosis of acute pancreatitis.
  • 2. Identify medications with possible, probable, or definite associations with acute pancreatitis.
  • 3. Discuss the usual course of acute pancreatitis and strategies for predicting severity of illness.
  • 4. Discuss the role of fluid replacement in the treatment of acute pancreatitis.
  • 5. Recommend appropriate nutritional support for patients with acute pancreatitis.
  • 6. Compare the place in therapy for various opioid analgesics used in the treatment of acute pancreatitis.
  • 7. Interpret the literature on the use of prophylactic antibiotics in acute pancreatitis.
  • 8. Differentiate between the different pathophysiologic mechanisms involved in the development of chronic pancreatitis.
  • 9. Assess a patient for chronic pancreatitis based on presenting signs and symptoms, lab values, and diagnostic studies.
  • 10. Recommend appropriate nonpharmacologic therapy for patients with chronic pancreatitis.
  • 11. Design individualized pharmacotherapeutic regimens for treating the pain associated with chronic pancreatitis.
  • 12. Justify the use of pancreatic enzyme supplements for the treatment of malabsorption associated with chronic pancreatitis.
  • 13. Discuss the advantages and disadvantages of the various dosage forms of the currently available pancreatic enzyme supplements.
  • 14. Justify the use of adjunctive antisecretory agents in the treatment of patients with chronic pancreatitis.
  • 15. Design an evaluation and monitoring plan for patients receiving therapy for chronic pancreatitis.

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Pancreatitis is inflammation of the pancreas with variable involvement of regional tissues or remote organ systems.1Acute pancreatitis is characterized by severe pain in the upper abdomen and elevations of pancreatic enzymes in the blood.13 In the majority of patients, acute pancreatitis is a mild, self-limiting disease ...

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