Chronic Pancreatitis

Question 1

What is chronic pancreatitis?

Answer 1

Recurrent or persistent abdominal pain and progressive injury to the pancreas resulting in scarring and loss of function.

Question 2

What are the causes of chronic pancreatitis?

Answer 2

Alcohol, idiopathic, gallstones, haemochromatosis, cystic fibrosis, congenital.

Question 3

What is this a presentation of?
Epigastric abdominal pain radiating to the back, dull, worse post-prandially, relieved by sitting forwards. Steatorrhea, anorexia, weight loss, malnutrition, diabetes.

Answer 3

Chronic pancreatitis

Question 4

What are the risk factors for chronic pancreatitis?

Answer 4

Alcohol, smoking, family history, coeliac disease.

Question 5

How is chronic pancreatitis investigated?

Answer 5

1. IFG, IGT, DM
2. AXR may show pancreatic calcifications
3. CT scan most sensitive for pancreatic calcifications, USS if not available.
4. Reduced faecal elastase
5. Amylase and lipase usually normal
6. Be sure to it exclude pancreatic cancer.

Question 6

What is the management for chronic pancreatitis?

Answer 6

1. Stop drinking and smoking
2. Low fat diet
3. Analgesia
4. Pancreatic enzymes (Creon) and PPI
5. Insulin needs maybe high or variable
6. Pancreatectomy for those with intractable pain
7. ERCP if biliary obstruction