frontal
Forum Guru
Topics: 53
Posts: 421
|
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 expect
A) Diabetes mellitus B) Malabsorption of fat-soluble vitamins D and K C) Guaiac-positive stool D) Courvoisier’s sign
|
| ARJ
Forum Guru
Topics: 133
Posts: 792
|
B) Malabsorption of fat-soluble vitamins D and K
Most probably Chronic Pancreatitis
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| mani
Forum Guru
Topics: 104
Posts: 1,403
|
Yep B
___________________
Sincerity and hard work are the keys to success!
|
| DrS
Forum Elite
Topics: 32
Posts: 338
|
B
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
The answer is A, diabetes mellitus.
Chronic pancreatitis has occured due to pancreatic damage from recurrent 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’s sign is a palpable, nontender gallbladder in a jaundiced patient. This finding suggests the presence of a malignancy, especially pancreatic cancer. Chronic pancreatitis per se does not produce guaiac-positive stools.
*Another source specifies that overall, 30% of patients with chronic pan. are diabetic, but the figure rises to 70% in those with chronic calcific pan.
|
| mani
Forum Guru
Topics: 104
Posts: 1,403
|
well fine, DM can occur, no doubt. The absorption of vit D & K is not dependent on lipase but in pancreatitis there will be malabsorption of fat that would lead to deficiency of fat soluble vitamins
___________________
Sincerity and hard work are the keys to success!
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
Think so? I will try and confirm. 
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
Harrison's mentions that 'clinically apparent deficiency of fat-soluble vitamins is surprisingly rare' in chronic pancreatitis.
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,488
|
I have checked Greenfield (surgery´s book) and it says malabsorption occurs after 90% of the pancreatic tissue has been destroyed, while endocrine insufficiency occurs after 80% of the endocrine cells have been destroyed. It also says that a clinically important vitamin deficiencies are relatively uncommon.
So, maybe it occurs first the glucose intolerance and later the malabsorption and that could explain the answer here. But definitively both occur and not uncommonly. And in the question the patient most probably has both.
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
The malabsorption that occurs after 90% pancreatic tissue has been destroyed is fat malabsorption (and later, protein). In our case, malabsoption of fat-soluble vitamins is being referred to, which, even as per your data, is uncommon (even in the face of fat malabsorption, when more than 90% of the tissue is destroyed).
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,488
|
ok, i think i got it. 
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
very interesting subject 
|
|
| |
| | | | | | | | | | | | |
Similar forum topics