Master the board step 3

Gastroenterology
Treatment
Treat with tetracycline or trimethoprim/sulfamethoxazole (TMP/SMX) for
12 months.
Chronic Pancreatitis
Look for a history of alcoholism and multiple episodes of pancreatitis. The
amylase and lipase levels will most likely be normal, since the fat malabsorption
does not develop until the pancreas is burnt out and largely replaced by
calcium and fibrosis. Malabsorption of fat-soluble vitamins, such as vitamin K
and vitamin D, is less common than with celiac disease.
Diagnostic Testing
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Best initial tests:
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Abdominal x-ray is 50–60 percent sensitive for the detection of pancreatic
calcifications.
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Abdominal CT scan (without contrast) is 60–80 percent sensitive.
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Most accurate test: Secretin stimulation testing.
Basic Science Correlate
A normal person should release a large volume of bicarbonate-rich
pancreatic fluid in response to the intravenous injection of secretin.
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Iron and folate levels will be normal, since pancreatic enzymes are not necessary
to absorb these. D-xylose testing will be normal. BIZ levels can be low.
Treatment
Replace the pancreatic enzymes chronically by mouth. Amylase, lipase, and
trypsin can be combined in one pill for chronic use.
Irritable Bowel Syndrome
Irritable bowel syndrome is a pain syndrome with altered bowel habits. This
condition presents with the following symptoms:
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Abdominal pain relieved by a bowel movement
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Abdominal pain that is less at night
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Abdominal pain with diarrhea alternating with constipation
Irritable bowel syndrome
presents with pain. There
is no fever, no weight loss,
and no blood in the stool.
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