A 52-year-old female presents with continuous abdominal pain that intensifies after eating. She is diagnosed with chronic pancreatitis. Contributing factors include:

Choice A reason:
Alcohol abuse is the leading cause of chronic pancreatitis in many cases. Chronic alcohol consumption leads to repeated episodes of pancreatic inflammation, resulting in fibrosis, loss of pancreatic function, and structural damage. Alcohol directly stimulates pancreatic secretions and contributes to the formation of protein plugs that obstruct pancreatic ducts, exacerbating the condition.
Choice B reason:
Bulimia is not a known contributing factor for chronic pancreatitis. While eating disorders can have gastrointestinal manifestations, they do not directly lead to the chronic inflammatory process seen in pancreatitis.
Choice C reason:
A history of gallstones is a recognized contributing factor to chronic pancreatitis. Gallstones can intermittently block the pancreatic duct, leading to inflammation and damage over time. While gallstones are more commonly associated with acute pancreatitis, they also play a role in the chronic form if untreated or recurrent.
Choice D reason:
Bacterial infection is not a primary contributing factor to chronic pancreatitis. While infections can complicate pancreatic conditions, they do not typically initiate the chronic inflammatory process. Chronic pancreatitis is more often caused by mechanical, toxic, or genetic factors rather than infectious agents.

Choice A reason:
Morphine is not most effective when given orally due to the high first-pass effect. The first-pass effect refers to the metabolism of a drug in the liver immediately after it enters the bloodstream from the gastrointestinal tract, significantly reducing the amount of active drug that reaches systemic circulation. Therefore, oral administration of morphine is not the most effective route because much of it is metabolized before it can exert its effect.

Choice B reason:
Morphine will be more effective when given via a non-enteral route such as intravenous (IV) or subcutaneous (SQ) because these routes bypass the liver, thereby avoiding the first-pass metabolism. This allows a higher concentration of the active drug to reach the systemic circulation, providing a more potent and effective pain relief.

Choice C reason:
Oral and IV administration of morphine do not have the same effect due to the first-pass metabolism. When morphine is administered orally, a significant amount is metabolized by the liver before it reaches the systemic circulation, whereas IV administration delivers the drug directly into the bloodstream, bypassing the liver and allowing a higher active concentration.

Choice D reason:
Morphine is not primarily excreted by the lungs; it is mainly metabolized by the liver and excreted by the kidneys. This statement does not accurately demonstrate an understanding of the first-pass effect or the pharmacokinetics of morphine.