Jim Ski's List: GI

• Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.
• Pancreatic calcification can often be seen on X-rays, as well as CT scans.
• biliruin and alkaline phosphatase can be elevated, indicating possible compression of the intrapancreatic bile duct due to edema, fibrosis, or cancer
• 
   While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis

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• Ischemic pancreatitis also may occur and is associated with epigastric pain. Laboratory studies reveal mildly elevated amylase and lipase. Steatorrhea may be observed.

• Abdominal Angina
• Relieved by defecation
• Patients who are affected describe widened dermatomal distributions of referred pain
• Both colonic inflammation and small bowel inflammation
• This has led to proposed treatments with probiotics and antibiotics
• The development of symptoms in people older than 40 years does not exclude IBS but should prompt a closer search for an underlying organic etiology
• Symptoms not consistent with IBS include the following:
• Onset in middle age or older
• Nocturnal symptoms
• Anorexia or weight loss
• Steatorrhea
• sigmoid tenderness
• Lubiprostone (Amitiza)

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