NASPGHAN - 2011 PG Course – Module A – Recurrent and Chronic Pancreatitis: How to Manage
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Posttest Questions
All of the following may be used as part of criteria to make a diagnosis of Acute Pancreatitis in a child
EXCEPT:
Epigastric pain x 2 days
Amylase level 3 times upper limits of normal
Lipase level 2 times upper limits of normal
Ultrasound demonstrating pancreatic and peri-pancreatic edema
Computer tomography scan demonstrating diffuse pancreatic swelling
A 5 year old child with seizure disorder presents with vomiting and abdominal tenderness. Lipase values are 6x upper limits of normal. Medications include valproic acid and melatonin. There is no history of trauma nor fever. Family history is unremarkable. The child is stable. Laboratory tests reveal normal CBC, liver enzymes, triglycerides, calcium values. Abdominal ultrasound reveals a mildly prominent pancreas without any signs of chronicity; the liver, gallbladder and biliary tree are all within normal limits. What would be
your
next step?
Discontinue the valproic acid
ERCP
Cholecystectomy
Sweat chloride
CT scan
All of the following genes have been implicated in ARP and/ or CP
EXCEPT:
CFTR
SPINK1
PRSS1
SBDS
CTRC
Which of the following would
NOT
generally be considered "baseline" or "first line" investigations in an 8 year old child presenting with first attack of acute pancreatitis, mild severity, without obvious etiology nor family history?
Liver enzyme panel
CFTR gene panel
Triglyceride level
Calcium 2+ level
Abdominal ultrasound
A 12-year old girl presents to the ED with acute pancreatitis. After assessing her as having a moderately severe case of acute pancreatitis, you decide to admit her to GI service. The first 24 hours focus on fluid resuscitation, and she does well. Remembering a recent presentation you heard on medical and nutritional management of pancreatitis, you decide the recommended NEXT STEP in management is:
Calling the PICC line team to place long-term venous access
Starting the patient on peripheral parenteral nutrition
Order the patient NPO status
Place nasogastric tube in anticipation of enteral feeds
The best available evidence to support early enteral feedings in the setting of acute pancreatitis include all the following outcomes EXCEPT:
Reduced incidence of infections
Reduced multi-organ failure
Reduced mortality
All of the above have been shown
Your patient follows-up in the clinic after her discharge and wants to discuss how to prevent further episodes of pancreatitis. You recommend all the following as
options
EXCEPT:
Antioxidants/micronutrients
Low-fat diet
Pancreatic enzymes
Antibiotics
Potential complications of chronic, recurrent pancreatitis includes chronic pain syndrome. Patients presenting with chronic, recurrent pancreatitis and chronic pain need to be particularly screened for:
Eating disorders
Depression
Obesity
Learning disability
A 14 year old female has had her second episode of acute pancreatitis. Her evaluation to date has shown a normal abdominal ultrasound, normal triglyceride and calcium, a negative sweat chloride test and no evidence for infectious, metabolic or drug induced pancreatitis. You have decided to perform further imaging as part of the evaluation. The best option in this setting would be:
Repeat abdominal Ultrasound
MRCP
ERCP
Endoscopic Ultrasound
The MRCP in the above mentioned patient is normal with a normal biliary tree and pancreatic duct. She has had another episode and is looking for further options. Repeat laboratory evaluation demonstrates no causes. Genetic testing has not shown a mutation in CFTR, SPINK1 or PRSS. In considering the further endoscopic options for her in this scenario, which procedure has the highest likelihood of finding a cause for her recurrent pancreatitis?
a. ERCP without sphincter of Oddi manometry
b. ERCP with sphincter of Oddi manometry
c. Endoscopic US alone
ERCP with SOD manometry is performed and pancreatic ductal hypertension is found. Which of the following has highest success rate in reducing episodes of pancreatitis
Bile duct sphincterotomy alone
Pancreatic duct stent alone
Pancreatic duct sphincterotomy alone
Dual duct sphincterotomy
A 12 year old boy with chronic pancreatitis due to PRSS mutation (hereditary pancreatitis) has had multiple episodes of pancreatitis and has been hospitalized 5 times in the last year. He has failed endoscopic treatments and is on chronic pain medications and has missed 25% of the school days in the last year. In considering surgical options of this boy, which statement is true.
Frey procedure leads to significant improvement in pain in 50% & eliminates risk of pancreatic cancer
Total pancreatectomy & islet cell autotransplantation leads to pancreatic sufficiency & no insulin need
Lateral pancreaticojejunostomy has a better success rate for pain relief than the Frey procedure
All surgeries offer 75%-85% improvement rate & choice depends on surgical expertise & family goals
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Please rate the following:
The program was relevant to my work.
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Content matched stated objectives.
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How well did the educational activity give a balanced view of therapeutic options, including the use of generic names?
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If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree,' please explain:
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Objective1: Discuss definitions of recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 2: Discuss how to evaluate for causes of recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 3: Discuss the genetics of recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 4: Discuss medical therapies of recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 5: Discuss nutritional implications of recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 6:Discuss rationale for timing of initiation of feeding in the acute setting
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 7: Describe the indications for endoscopy in recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 8: Discuss the endoscopic therapeutic interventions for recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Objective 9: Discuss the surgical options for recurrent and chronic pancreatitis
By meeting the above objective, my professional competence will increase, because I have acquired new strategies to use in my practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my professional performance will improve, because I should be able to implement the new strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
By meeting the above objective, my patient outcomes should improve, due to the implementation of newly learned strategies.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Please answer the following:
Do you believe this activity was appropriate for the scope of your professional practice?
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Was the educational content scientifically sound?
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Was the educational content free from commercial bias?
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No
Was the mode of education effective for learning?
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No
If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?
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No
NA
If you answered 'No' to any of the above questions, please explain:
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What did you learn during this activity that you intend to integrate into your practice?
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