[42] Chronic Pancreatitis Flashcards
What is chronic pancreatitis?
Long-standing inflammation of the pancreas that alters the organs normal structure and functions
What can chronic pancreatitis present as?
Episodes of acute inflammation in previously injured pancreas, or chronic damage with persistent pain and malabsorption
Is the damage in chronic pancreatitis reversible?
No, unlike in acute pancreatitis
What is the underlying mechanism of disease in chronic pancreatitis?
Unclear
What is the most common theory as to the mechanism of disease in chronic pancreatitis?
Obstruction or reduction of bicarbonate excretion, which in turn leads to activation of pancreatic enzymes, which leads to pancreatic tissue necrosis with eventual fibrosis
What are the other theories as to the mechanism of disease of chronic pancreatitis?
- Epigenetic degeneration
- Alcohol-induced precipitation of proteins in the ductular structure of the pancras, leading to local pancreatic dilation and fibrosis
- Direct toxic effects of alcohol on the pancreas
What is the end result of the disease process in chronic pancreatitis?
The end result is pancreatic fibrosis
How long does pancreatic fibrosis take to develop?
Can take several years
What forms can chronic pancreatitis occur in?
- Large duct
- Small duct
What happens in large duct chronic pancreatitis?
There is dilation and dysfunction of the large pancreatic ducts
Is large duct pancreatitis visible on imaging?
Yes, on most
What happens to the pancreatic fluid in large duct pancreatitis?
It changes composition
What is the result in the changes in pancreatic fluid composition in large duct pancreatitis?
It facilitates the deposition of precursors to calcium carbonate stones
What does the deposition of precursors to calcium carbonate stones cause in large duct pancreatitis?
Diffuse pancreatic calcification
Who is large duct pancreatitis more commonly found in?
Males
Why is small duct pancreatitis difficult to diagnose?
Because it is usually associated wtih normal imaging and no pancreatic calcification
Who is small duct pancreatitis predominantly found in?
Females
What is the greatest risk factor for chronic pancreatitis?
Excess alcohol consumption
What % of people who are alcohol dependant develop chronic pancreatitis?
5-10%
What has emerged as a risk factor for chronic pancreatitis?
Smoking
Other than chronic pancreatitis, how else can smoking affect the pancreas?
Increases the risk of pancreatic malignancy
What are the causes of chronic pancreatitis?
- Chronic alcohol abuse
- Idiopathic
- Metabolic
- Infection
- Herediatry
- Autoimmune
- Obstruction of pancreatic duct
- Congenital
What % of chronic pancreatitis cases are caused by chronic alcohol abuse?
60%
What % of chronic pancreatitis cases are idiopathic?
30%
What are the metabolic causes of chronic pancreatitis?
- Hyperlipidaemia
- Hypercalcaemia
What are the viral causes of chronic pancreatitis?
- HIV
- Mumps
- Coxsackie
What are the bacterial causes of chronic pancreatitis?
- Echinococcus
What are the hereditary causes of chronic pancreatitis?
Cystic fibrosis
What are the autoimmune causes of pancreatitis?
- Autoimmune pancreatitis
- SLE
What can cause an obstruction of the pancreatic duct causing chronic pancreatitis?
- Stricture formation
- Neoplasm
What are the congenital causes of chronic pancreatitis?
- Pacreas divisum
- Annular pancreas
What is the major symptom of chronic pancreatitis?
Chronic pain
What might the chronic pain in chronic pancreatitis be complicated by?
Recurring attacks of acute pancreatitis
Where is the pain felt in chronic pancreatitis?
Typically in the epigastrum, and radiates to the back
What may ease the pain in chronic pancreatitis?
Leaning forwards
What may be associated with the pain in chronic pancreatitis?
Nausea and vomiting
What other symptoms may a patient with chronic pancreatitis present with?
- Symptoms of endocrine dysfunction, such as diabetes mellitus
- Symptoms of exocrine dysfunction, such as steatorrhoea or malabsorption
How is chronic pancreatitis investigated?
- Imaging
- BM
- Serum calcium
- LFTs
- Faecal elastase