Chronic pancreatitis Flashcards

1
Q

What are the causes of chronic pancreatitis?

A

recurrent inflammation leading to destruction of exocrine & endocrine tissue -> fibrous scar

  • alcohol
  • gallstone
  • congenital or acquired stricture of the pancreatic duct
  • pancreas divisum
  • tumor causing duct obstruction
  • inflammation of papilla of Vater
  • cystic fibrosis
  • hypercalcemia
  • idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the gross picture of chronic pancreatitis?

A
  • early -> pancreas is enlarged, edematous, & indurated
  • advanced -> small, reduced to cord with rubbery consistency
    - > ducts are dilated but may be narrow & distorted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the microscopic picture of acute pancreatitis?

A
  • early -> lesion are spotty, show dilatation of the acini with intra-lobular & peri-lobular fibrosis
  • advanced -> fibrosis extends through gland but some lobules are still not completely affected
  • most advanced -> pancreas is entirely replaced by fibrous tissue
    - > cysts are found where the duct epithelium is destroyed
    - > islets of Langerhans are hyperplastic & non functioning -> diabetes
    - > perineural sheath of intrapancreatic nerves are irritated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What extrapancreatic involvement will occur due to chronic pancreatitis?

A
  • CBD -> persistent constriction of duct due to head of pancreas inflammation -> stricture formation
  • duodenum -> obstructed by inflammation of the head of pancreas
  • colon -> partial obstruction in transverse colon or splenic flexure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features of chronic pancreatits?

A
  • abdominal pain -> cramping dull, & aching in the epigastrium radiating to subcostal area & to the back
    - > recurrent (several days to weeks)
    - > spontaneous relief -> exocrine function is lost
  • weight loss -> malabsorption & decreased food intake due to pain
  • steatorrhea & creatorrhea -> bulky offensive oily stool (floating)
  • diabetes mellitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What lab findings could be seen in case of chronic pancreatitis?

A
  • early -> serum amylase & lipase increase during inflammation
  • late -> normal
  • abnormal liver function tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What radiological features are seen in chronic pancreatitis?

A

X RAY -> pancreatic calcification
MRCP -> pancreatic cyst
-> biliary dilatation
CT -> ductal anatomy
-> pseudocysts & cystic communication with ductal system
-> biliary dilatation & level of duct obstruction
ERCP -> main pancreatic duct dilatation, stricture, cysts, & ductal calculi
-> angulation of distal CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the medical treatment of chronic pancreatitis?

A
  • pancreatic insufficiency -> dietary restriction of fat (50gm) then increase till diarrhea appears
    - > enzyme replacement
  • DM -> subcutaneous insulin -> fasting glucose level = 200 -> may cause hypoglycemia due to glucagon deficiency
  • stop alcohol intake -> pain cessation
  • minimize stimulus to secretion -> semisolids or liquid diet
  • narcotic analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the surgical treatment of chronic pancreatitis?

A

PANCREATICOJEJUNOSTOMY (PUESTOW PROCEDURE)
- only in enlarged duct (7mm or larger) -> drainage into jejunum

PANCREATICODUODENECTOMY (WHIPPLE)

DISTAL PANCREATECTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the indications for Whipple’s procedure?

A
  • inability to rule out presence of pancreatic cancer
  • failure of previous pancreaticojejunostomy
  • localized chronic pancreatitis
  • pain relief
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the indications of distal pancreatectomy?

A
  • recurrent episodes of pancreatitis with multiple pseudocyst in pancreatic tail & splenic vein thrombosis
  • recurrent episodes with stricture in the main duct in the body or tail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be done for pain relief in case of failure of narcotics & dependence?

A

DESTRUCTION OF THE CELIAC GANGLION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly