CHRONIC PANCREATITIS
| A | Total Parental Nutrition | |
| B |
Feeding Gastrostomy |
|
| C |
Feeding Jejunostomy |
|
| D |
Oral feeding |
A patient undergoes a prolonged and complicated pancreatic surgery for chronic pancreatitis. Most preferred route for supplementary nutrition in this patient would be:
| A |
Total Parental Nutrition |
|
| B |
Feeding Gastrostomy |
|
| C |
Feeding Jejunostomy |
|
| D |
Oral feeding |
When a patient has undergone a prolonged and complicated pancreatic surgery, the recovery of the patient will require a form of nutrition that gives rest to the pancreas and protect the pancreatic anastomosis.
A feeding jejunostomy in such a case can provide supplementary nutrition and also gives protection to the pancreatic anastomosis and cause minimal stimulation of pancreatic secretion thereby giving rest to the pancreas.
| A |
Anaphylactic shock |
|
| B |
Carcinomatosis |
|
| C |
Disseminated infection |
|
| D |
Intestinal hemorrhage |
Maldigestion of protein and fat is manifested in chronic pancreatitis only if the damage of pancreatic tissue exceeds?
| A |
30 % |
|
| B |
50 % |
|
| C |
90 % |
|
| D |
75 % |
There is a very large reservoir of pancreatic exocrine function. > 90% of the pancreas must be damaged before maldigestion of fat and protein is manifested.
Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 2629
Most common cause of chronic pancreatitis:
| A |
Gall stones |
|
| B |
tropical pancreatitis |
|
| C |
pancreas divisium |
|
| D |
Alcohol |
Ans is d i.e. Alcohol
“Worldwide, alcohol consumption and abuse is associated with chronic pancreatitis in up to 70% of cases “Schwartz
Pt. with chronic pancreatitis gives chain of lakes appearance in ERCP examination. Management is:
| A |
Total pancreatectomy |
|
| B |
Sphincteroplasty |
|
| C |
Side to side pancreatico jejunostomy |
|
| D |
Resecting the tail of pancreas and performing a pancreatojejunostomy |
Ans. is ‘c’ ie. side to side pancreatico jejunostomy
Areas of ductal dilatation alternating with areas of ductal stenosis are common finding in alcoholic patients who have severe chronic pancreatitis.
This type of duct obstruction cannot be relieved by a sphincteroplasty because of multiple areas of stenosis along the duct.
Although total pancreatectomy would be a beneficial approach, mortality and morbidity rate with this procedure are extremely high.
Thus the procedure of choice in this pt. is side to side pancreaticojejunostomy in which the duct is opened longitudinally through the chain of lakes. A Roux-en-Y limb of jejunum should then be brought up for anastomosis with the opened pancreas in side-to-side fashion.
| A |
Portal vein thrombosis |
|
| B |
Pancreatic abscess |
|
| C |
Pseudocyst |
|
| D |
Pancreatic head mass |
Ans is ‘c’ i.e. Pseudocyst
“Pseudocysts occur in up to 10% of patients with acute pancreatitis, and in 20 to 38% of patients with chronic pancreatitis, and thus, they comprise the most common complication of chronic pancreatitis.”
Pain relief in chronic pancreatitis can be obtained by destruction of –
| A |
Celiac ganglia |
|
| B |
Vagus nerve |
|
| C |
Anterolateral column of spinal cord |
|
| D |
None of the above |
Ans. is ‘a’ i.e., Celiac ganglia
All are features seen in Chronic Pancreatitis except ‑
| A |
Chronic persistent pain |
|
| B |
Diarrhoea, Steatorrhoea |
|
| C |
Calcification |
|
| D |
Paralytic ileus |
Ans. is ‘d’ i.e., Paralytic ileus
A patient undergoes a prolonged and complicated pancreatic surgery for chronic pancreatitis. Most preferred route for supplementary nutrition in this patient would be:
| A |
Total Parenteral Nutrition |
|
| B |
Feeding Gastrostomy |
|
| C |
Feeding Jejunostomy |
|
| D |
Oral feeding |
Ans. is ‘c’ i.e. Feeding jejunostomy
- A feeding jejunostomy is a preferred procedure to provide supplementary nutrition in this patient as it provides protection to the pancreatic anastomosis and causes minimal stimulation of pancreatic secretion thereby giving rest to the pancreas.
- After pancreatic surgery, TPN should or only be used when there is intolerance to enteral nutrition or enteral nutrition is contraindicated.
- Pancreatic surgery does not usually interfere with the function of the gastrointestinal tract and the enteral route remains the preferred mode for providing nutrition.
Contraindications for operations where Early Oral Feeding-
- Esophageal resection
- Gastric resection
- Major Hepatic Surgery
- Major Pancreatic Surgery
