Chronic Pancreatitis

Question 1

Causes of chronic pancreatitis (AGITS)

Answer 1

Alcohol + autoimmune

Genetic - CF

Immune + infection -HIV, mumps, coxsackie

Triglycerides increased

Structural abnormality - obstruction by tumour

Question 2

Presentation of chronic pancreatitis

Answer 2

• chronic pain epigastric pain radiating to back
- Relieved by sitting back or hot water bottle
- Exacerbated by fatty food or EtOH
• Steatorrhoea and wt. loss
• DM: polyuria, polydipsia
• Epigastric mass: pseudocyst

Question 3

Investigations of chronic pancreatitis

Answer 3

• ↑ glucose
• ↓ faecal elastase: ↓ exocrine function
• USS: pseudocyst
• AXR: speckled pancreatic calcifications
• CT abdomen with IV contrast : pancreatic calcifications - first line

MRCP - gold standard

Question 4

Tx of chronic pancreatitis

Answer 4

Conservative:
• Diet
- No EtOH
- ↓ fat, ↑ carb

Pharmacological:
• Analgesia: may need coeliac plexus block
•  Enzyme supplements: 
- pancreatin (Creon)
- ADEK vitamins
- DM mx 

Surgery

• Distal pancreatectomy
• Whipple’s
• Pancreaticojejunostomy: drainage
• Endoscopic stenting

Question 5

Indications for surgery for chronic pancreatitis

Answer 5

• Unremitting pain
• Wt. loss
• Duct blockage

Question 6

Complications of chronic pancreatitis

Answer 6

• Pseudocyst
• DM
• Pancreatic Ca
• Pancreatic swelling → biliary obstruction
• Splenic vein thrombosis → splenomegaly

Question 7

Male to female ration

Answer 7

4:1

Question 8

Amylase or lipase levels

Answer 8

Not raised