Subject 29 - Chronic pancreatitis
(3 hours)
Place
Training Room, department of gastroenterology, ultrasound room .
Purpose
To know:
• Identify the major forms of chronic pancreatitis.
• The value of the major etiological factors that lead to the emergence of this disease.
• International and Marseille -Roman classification of chronic pancreatitis.
• Features of the clinical course of the main forms of chronic pancreatitis , laboratory and
instrumental diagnosis and differential diagnosis , depending on the shape and location of the
pathological process.
• Major complications : infectious and noninfectious
• Laboratory and instrumental methods in the diagnosis of various forms of chronic pancreatitis.
• The differential diagnosis of chronic pancreatitis from peptic ulcer , chronic cholecystitis,
pancreatic cancer
• Principles of differential treatment of different forms of chronic pancreatitis using dietary
methods and drugs and non-drug treatments.
• Fixed primary and secondary prevention .
• Weather and performance depending on the degree and form of the pathological process.
Be able to:
• Conduct a survey and physical examination of patients with chronic pancreatitis
• justify the use of the basic diagnostic methods for diagnosis of chronic pancreatitis determine
the indications and contraindications for their conduct
• Identify the typical clinical picture of various forms of chronic pancreatitis
• Identify key variants of the course and complications of chronic pancreatitis
• to the differential diagnosis of various forms and degree course pancreatitis and formulate
clinical diagnosis in ICD-10
• develop a plan of inspection of patient with chronic pancreatitis
• appoint the treatment of various forms of chronic pancreatitis using dietary methods, drugs and
non-drug treatments
• conduct primary and secondary prevention of various forms of chronic pancreatitis
Professional orientation of students
Chronic pancreatitis have a greater prevalence of knowledge necessary for early detection and
differential diagnosis with other gastroenterological diseases. The need for right use of modern
methods of clinical , laboratory and instrumental examination for the purpose of timely diagnosis
and adequate treatment , thus preserving the performance of patients and prevent complications.
Basic knowledge and skills
№
1.
Discipline
Anatomy
2,
Physiology
3.
Biochemistry
to know
Anatomical structure of the
pancreas
Physiology of the pancreas . The
role of enzymes in the digestive
process
Composition of pancreatic juice
To be able
4.
Pathophysiology
5.
Propedevtika internal
diseases
Mechanisms violations
formation and excretion of
pancreatic juice
Semiotics of disorders of the
pancreas
to evaluate clinical
and laboratory studies
Plan for practical lesson
№
Elements of practical employments
Time(minutes)
1. Verification of present's students
5
2. Entrance control and his analysis
15
patients for Supervision ( card or clinical tasks )
3. Distributing
*
5
patients or study of educational hospital chart
4. Review
*
30
5. Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
30
6. Exercises with clinical formulations for solving clinical situation tasks
15
7. Output control of knowledge and its evaluation
15
8. Results and final assessment of knowledge and skills of students and tasks to
self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical issues addressed in class
1. Definition of chronic pancreatitis.
2. The value of different etiological factors.
3. Classification (ICD- 10).
4. Features of the clinical course of various clinical forms , diagnosis and differential diagnosis ,
depending on the shape and location of the pathological process.
5. Complications: infectious and noninfectious .
6. Methods of clinical , laboratory, research tool in the diagnosis of pancreatitis.
7. Differential treatment of various forms of chronic pancreatitis.
8. Primary and secondary prevention .
9. Weather and performance
Methods of practical classes
(* The first lesson the teacher carries out safety training (if any condition) , which is celebrated
in the magazine signed by student teacher ).
After reviewing the present teacher carries out a written entrance control basic knowledge . Then
the instructor carries out the distribution of students for Supervision of patients and determine
their problem.
№
Task
Instructions a student
Note: teacher for
students
1.
To provide curation of
patient with chronic
pancreatitis
In the survey reveal :
1. Signs violation of exocrine
pancreatic function
2. Characteristic clinical
manifestations of chronic
pancreatitis , changes in laboratory
parameters, changes in pancreatic
ultrasound , x-ray changes ,
endoscopic retrograde changes
during
холецистохолангіопанкреатографії
( ERCP)
3. The degree of chronic pancreatitis
Pay particular
attention to the
identification of
possible etiologic
factors.
Motivate different
levels course of
chronic pancreatitis
Teachers work according to the plan of studies, spend the weekend at the end of the control
knowledge. Before the end of class the teacher sums up the results of his studies on the
assessment of each student and announce the topic of the next session.
Visual material
1. VCR , overhead projector .
2. Tables and slides
3. Educational history.
4. DVD drive with Ultrasound examination of the pancreas
5. A set of situational tasks and test tasks.
Forms and methods of selfTests
1. By enzyme preparations should include :
A. Alohol .
B. Magnesium sulfate .
C. Pancreatin .
D. Sodium salicylate .
E. Nifuroksazyd .
2. Chronic pancreatitis in a patient's blood high :
A. bilirubin
B. ALT .
C. Amylase .
D. Timolovoyi sample.
E. Cholesterol .
3. By the Marseille - Rome classification include
A. Chronic calcificational pancreatitis.
B. Island pancreatitis.
C. Recurrent pancreatitis.
D. Chronic pancreatitis.
E. Chronic pancreatitis latency .
Situational tasks
1. Sick '47 complains of pain in the left upper quadrant, epigastrium after taking fatty foods and
alcohol, meteorism , weakness. Ob-no : Abdomen sensitive to palpation in both upper quadrant,
epigastrium. In biochemical analysis of blood (liver complex) revealed increasing levels of
amylase twice. With ultrasound liver not enlarged, granular structure , not enlarged gallbladder ,
pancreas enlarged, heterogeneous structure , granular, ehohenist increased. What is the most
likely diagnosis ? What do I need to clarify the etiology of the process? Assign the required
treatment .
2. The patient is 52 years old. Complains of intense pain in the upper abdomen radiating to the
left , anorexia, nausea, zakrepyy . Seizures are up to 2-3 times a year. Three years ago
cholecystectomy. After half a year after the operation was again an attack of severe pain .
Appeared mild jaundice, increased levels of urinary diastase . Ultrasound, ERCP and stones in
the ducts not found. OBJECTIVE: subikterychnist sclera. Pain at the points Desjardins ,
Gubergrits , Mayo -Robson. Blood analysis without pathological changes. The aggravation of the
disease which occurs ? Assign the required treatment .
Sources
of
information
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
Individual Students Program topics
Explore :
• Chronic pancreatitis : etiology , options disturbances in the formation of pancreatitis.
• Principles of treatment of chronic pancreatitis: dietary , medical and nemedikamentozne
treatment.
• Significance of the infection, nutritional factors and chronic diseases of the gastrointestinal
tract in the development of chronic pancreatitis.
• Clinical course and extent of chronic pancreatitis, clinical features of different forms of
pancreatitis.
• The role of laboratory and instrumental methods of diagnosis and differential diagnosis of
chronic pancreatitis.