Chronic Pancreatitis

Question 1

• is a disease process characterized by irreversible damage to
  the pancreas
• stellate cell activation that results in cytokine expression and production of extracellular matrix proteins cause acute and chronic inflammation and collagen deposition in the pancreas
• defined by the presence of histologic abnormalities, including chronic inflammation, fibrosis, and progressive destruction of both exocrine and eventually endocrine tissue atrophy

Answer 1

CHRONIC PANCREATITIS

Question 2

Causes of Chronic Pancreatitis

Answer 2

• Adults: alcoholism
• Children: cystic fibrosis
• 25% - idiopathic form

Question 3

• presumed autoimmune causation with characteristic
  laboratory, histologic, and morphologic findings
• include AIP and idiopathic duct centric pancreatitis (IDCP)

Answer 3

AUTOIMMUNE PANCREATITIS

Question 4

• the pancreas is involved as part of an lgG4 systemic disease and meets HISORt criteria
• pancreatic histopathologic findings include lymphoplasmacytic infiltrate, storiform fibrosis, and abundant IgG4 cells

Answer 4

AIP

Question 5

histologically confirmed, with granulocytic infiltration of the duct wall (GEL), but without lgG4 positive cells and systemic
involvement

Answer 5

IDCP

Question 6

• Mild symptoms, usually abdominal pain, but without frequent attacks of acute pancreatitis
• Diffuse swelling and enlargement of the pancreas
• Two-thirds of patients present with either obstructive jaundice or a “mass” in the head of the pancreas mimicking carcinoma
• Diffuse irregular narrowing of the pancreatic duct (MRCP or ERCP)
• Increased levels of serum gamma globulins, especially!gG64
• Presence of other autoantibodies (ANA), rheumatoid factor (RF)
• Can occur with other autoimmune diseases: Sjégren’s syndrome, primary sclerosing cholangitis, ulcerative colitis, rheumatoid arthritis
• Extrapancreatic bile duct changes such as stricture of the common bile duct and Intrahepatic ducts
• Pancreatic calcifications (rare)
• Pancreatic biopsies reveal extensive fibrosis and lymphoplasmacytic infiltration
• Glucocorticoids are effective in alleviating symptoms, decreasing size of the pancreas, and reversing histopathologic changes

Answer 6

Autoimmune Pancreatitis (AIP)

Question 7

Tx for AIP

Answer 7

Glucocorticoids: Prednisone

Question 8

Tx for Refractory symptoms. A monoclonal antibody directed against B cells

Answer 8

Rituximab

Question 9

imaging initial modality of choice of AIP

Answer 9

Abdominal CT

Question 10

• diagnostic test with the best sensitivity and specificity
• hormone stimulation test
• abnormal when 260% of the pancreatic exocrine function
  has been lost

Answer 10

Secretin test

Question 11

Tx that improve pain in chronic pancreatitis and lower pain medication requirement

Answer 11

Pregabalin

Question 12

• ventral pancreatic anlage fails to migrate correctly to make
  contact with the dorsal anlage
• cause intestinal obstruction in the neonate or the adult
• Symptoms of postprandial fullness, epigastric pain, nausea,
  and vomiting
• Retrocolic duodenojejeunostomy

Answer 12

ANNULAR PANCREAS

Question 13

• embryologic ventral and dorsal pancreatic anlagen fail to fuse
• most common congenital anatomic variant of the human
  pancreas

Answer 13

PANCREAS DIVISUM