16. Surgical aspects of chronic pancreatitis (symptoms, diagnosis, treatment)

Question 1

Most common causes

Answer 1

• Chronic heavy alcohol use (60–70% of cases, esp. men)
• Pancreatic ductal obstruction
• Tobacco use
• Idiopathic pancreatitis

Question 2

Clinical features: pancreatic insufficiency

Answer 2

Steatorrhea (exocrine enzyme deficiency)

• Cramping abdominal pain, bloating, diarrhea
• Can lead to a deficiency of fat-soluble vitamins

Malabsorption and weight loss

Pancreatic diabetes (endocrine hormone deficiency)

Question 3

Main symptoms

Answer 3

Epigastric pain
Pancreatic insufficiency
nausea and vomiting

Question 4

Diagnosis

Answer 4

Pretty much same as acute pancreatitis

clinical picture
lab
imaging

Question 5

conservative treatment

Answer 5

Enzymatic replacement together with medical nutritional intervention to treat steatorrhea

Treatment of endocrine insuff.: DM, appr. 10-15 years after development of disease (function until 90-95% destruction of gland)

Question 6

Surgery in chronic pancreatitis

Answer 6

Symptomatic treatment

Hybrid operations - duodenum-preserving pancreatic head resection

• Beger procedure
• Frey procedure: lower morbidity and operation time

Malignancy or suspicion of cystic malignancy
- Pancreatic head tumor: Kausch-Wipple procedure (classic or pylorus preserving) is preferred over a duodenum preserving pancreatic head resection