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Clinical Alimentary System > 4.2. Pancreatic Disease - Chronic Pancreatitis > Flashcards

4.2. Pancreatic Disease - Chronic Pancreatitis Flashcards

1
Q

What is Chronic Pancreatitis?

A

The continuous inflammation of the Pancreas

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2
Q

What is Chronic Pancreatitis characterized by?

A
  1. Irreversible Glandular Destruction
  2. Pain
  3. Loss of Pancreatic Function
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3
Q

Is Chronic Pancreatitis more common in Males or Females?

A

Males

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4
Q

What age group is Chronic Pancreatitis most common in?

A

35-50 year olds

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5
Q

What geopgraphical location is Chronic Pancreatitis common / rare in?

A

Common - South of India

Rare - East Asia

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6
Q

What are the main Aetiologies of Chronic Pancreatitis?

A
  1. Alcohol Abuse (80% of cases)
  2. Congenital Anatomical Abnormalities
  3. Hypercalcaemia
  4. Hereditary Pancreatitis
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7
Q

What are the 2 main Congenital Anatomic Abnormalities?

A
  1. Annular Pancreas

2. Pancreas Divisum (The failed fusion of the Dorsal and Ventral Buds)

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8
Q

What genes are associated with Hereditary Pancreatitis?

A
  1. PRSS1
  2. SPINK1
  3. CFTR
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9
Q

What are the characteristics of PRSS1, in association with Chronic Pancreatitis?

A
  1. Cationic Trypsinogen is produced
  2. This is Autosomal Dominant with a High Penetrance Rate
  3. Diagnostic Testing / Screening is available
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10
Q

What are the characteristics of SPINK1, in association with Chronic Pancreatitis?

A
  1. This is a Pancreatic Secretory Trypsin Inhibitor
  2. This has a High Frequency but Low Penetrance in the Population
  3. There is no Diagnostic Testing / Screening available
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11
Q

What are the characteristics of CFTR, in association with Chronic Pancreatitis?

A
  1. This involves the Cystic Fibrosis Transmembrane Conductance Regulator
  2. This may be associated with Cystic Fibrosis, but the majoruty of these mutations have unknown clinical significance
  3. Diagnostic Testing is available (Sweat Chloride Test) and Screening for Cystic Fibrosis is available
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12
Q

What is the Pathology of Chronic Pancreatitis?

A

This is dependent on the Aetiology:

  1. Duct obstruction
  2. Abnormal Major Duodenal Papilla (Sphincter of Oddi) function
  3. General Polymorphism causing abnormal Trypsin Activation
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13
Q

What can cause Duct Obstruction?

A
  1. Calculi (Stones)
  2. Inflammation (Due to alcoholism or other irritant)
  3. Protein Plugs
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14
Q

What can cause Abormal Major Duodenal Papilla (Sphincter of Oddi) function?

A
  1. Spasm - not allowing the contents to be released

2. Relaxation problem - the inability to release the Digestive Enzymes

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15
Q

Due to the Aetiology, and the Initial Pathology, what changes occur in the Pancreas?

A
  1. The Ducts become Dilated, Tortuous and Strictured, due to Glandular Atrophy and Replacement of Normal Cells with Fibrous Tissue
  2. The Thick secretions may calcify
  3. Nerves may become exposed due to the loss of the Perineural Cells
  4. Portal Hypertension occurs due to the Thrombosis of the Alimentary Venous Drainage
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16
Q

What is the Clinical Presentation of Chronic Pancreatitis?

A
  1. Asymptomatic
  2. Abdominal Pain
  3. Anorexia
  4. Exocrine Insufficiency
  5. Endocrine Insufficiency
  6. Jaundice
  7. Miscellaneous Signs
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17
Q

When may Chronic Pancreatitis be Asymptomatic?

A

In the early stages of the disease

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18
Q

When does Abdominal Pain occur?

A

This is exacerbated by food and alcohol ingestion

19
Q

Does the Abdominal Pain get worse?

A

No, it decreases over time

20
Q

Why does Anorexia occur?

A

Due to the Pain associated with eating

21
Q

What may occur due to the Anorexia?

A

Weight Loss

22
Q

Why does Exocrine Insufficiency occur?

A

Due to the inability to break some foodstuff - because of the lack of Pancreatic Enzymes reaching the Chyme

23
Q

What occurs as a result of the Exocrine Insufficiency?

A

There is malabsorption of:

  1. Fat Soluble Vitamins (A, D, E, and K)
  2. Electrolytes (Mg and Ca)
  3. Proteins
24
Q

What condition may occur due to the Endocrine Insufficiency?

A

Diabetes Mellitus (In 30% of cases)

25
Q

Why might Jaundice occur?

A

If there is a blockage of the Common Bile Duct as well

26
Q

What type of Jaundice is occurring here?

A

Post-Hepatic (Cholestatic)

27
Q

What are the Miscellaneous Signs of Chronic PAncreatitis?

A
  1. Portal Hypertension
  2. Pancreatic Pseudocyst
  3. G.I. Haemorrhage
28
Q

What investigations are required for Chronic Pancreatitis?

A
  1. Serum Amylase / Lipase
  2. Serum Albumin / Calcium / Magnesium / Vitamin B12
  3. Blood Glucose
  4. Serum Inflammatory Markers (CRP and ESR)
  5. Gene Mutation Analysis
  6. Transabdominal / Endoscopic Ultrasound
  7. Contrast Enhanced CT / MRI / MRCP
  8. Liver Function Test (and Biochemistry)
  9. Pancreatic Function Test
29
Q

What will be shown in the Serum Amylase / Lipase in Chronic Pancreatitis?

A

The Levels may be Elevated, but in Advanced Disease

30
Q

What will be shown in the other Blood Tests in Chronic Pancreatitis?

A
  1. Decrease in Serum Albumin / Calcium / Magnesium / Vitamin B12
  2. Increase in Blood Glucose
  3. Increase in Serum Inflammatory Markers (CRP and ESR)
31
Q

When would a Gene Mutation Analysis be done?

A

When a genetic aetiology is suspected

32
Q

What is the purpose of a Transabdominal / Endoscopic Ultrasound?

A

This is used for the initial assessment and to assess for complications (i.e. Pseudocyst formation, Malignancy development)

33
Q

What is the purpose of a Contrast Enhanced CT / MRI / MRCP?

A

To provide a more detailed assessment of Pancreatic Damage (Calcification / Dilation)

34
Q

What is the purpose of a Liver Function Test (and Biochemistry)?

A

To eliminate other causes of the Symptoms

35
Q

What are the names of the Types of Pancreatic Function Test?

A
  1. Lundh

2. Pancreolauryl

36
Q

Why are Pancreatic Function Tests not essential?

A

These will not effect the treatment

37
Q

What is the treatment of Chronic Pancreatitis?

A
  1. Alcohol Cessation
  2. Analgesics
  3. Enzyme / Vitamin Supplements
  4. Insulin
38
Q

Why is Alcohol Cessation essential?

A

As this is most commonly the Primary Aetiology

39
Q

What Pain Medications are given?

A
  1. NSAID’s
  2. Opiates
  3. Antidepressants
  4. Coeliac Plexus Block
  5. Referral to the Pain Clinic
40
Q

What happens in a Coeliac Plexus Block?

A

The Sensory Nerves of the Coeliac Plexus are intentionally damaged, leaving them non-functional

41
Q

Why are Enzyme / Vitamin Supplements Essential?

A
  1. To assist with Pain Control
  2. As this allows for better absorption of foodstuff in the Small Intestines - Acid Suppression may be required so these are not hydrolysed in the stomach
42
Q

Why may Insulin be Required?

A

To treat the associated Diabetes

43
Q

What is the most common Structural Complication of Chronic Pancreatitis?

A

A Pancreatic Pseudocyst - Fluid collection around granulomatous tissue

44
Q

What is the treatment of the Pancreatic Pseudocyst?

A

Endoscopic Aspiration with Ultrasound

Clinical Alimentary System (64 decks)

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