Chronic Pancreatitis Flashcards
What is chronic pancreatitis?
It is defined as a condition in which there is chronic inflammation of the pancreas, resulting in permanent damage
What is the pathophysiology of chronic pancreatitis?
This inflammation is due to enzyme-mediated autodigestion, caused by hypersecretion or an accumulation of exocrine digestive enzymes – such as amylase and lipase
This leads to necrosis of pancreatic tissue
What are the six risk factors of chronic pancreatitis?
Alcoholism
Pancreatic Cancer
Pancreas Divisum
Annular Pancreas
Cystic Fibrosis
Haemochromatosis
What is the most common risk factor of chronic pancreatitis in adults?
Alcoholism
What is the most common risk factor of chronic pancreatitis in children?
Cystic fibrosis
What are the six clinical features of chronic pancreatitis?
Sudden, Severe Epigastric Pain
Back Pain Radiation
Abdominal Distension
Nausea & Vomiting
Appetite Reduction
Steatorrhoea
Describe the epigastric pain associated with chronic pancreatitis
The pain is relieved by sitting forward
The pain is worsened following meal consumption, usually after 15 - 30 minutes
How is steatorrhoea a clinical feature of chronic pancreatitis?
This is due to pancreatic insufficiency
When does steatorrhoea tend to present in chronic pancreatitis?
It develops between 5 and 25 years after the onset of pain
What additional feature is associated with chronic pancreatitis related to haemochromatosis?
A grey discolouration of the skin
What are the five investigations used to diagnose chronic pancreatitis?
Blood Tests
Ultrasound Scan
CT Scan
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Faecal Elastase
What two blood test results indicate chronic pancreatitis?
Increased Serum Lipase Levels > 3x Normal Level
Increased Serum Amylase Levels > 3x Normal Level
What are the three features of chronic pancreatitis on ultrasound scans?
Hyperechogenicity
Pancreatic Pseudocysts
Pancreatic Pseudoaneurysms
What is the gold standard investigation used to diagnose chronic pancreatitis?
CT Scan
What are the three features of chronic pancreatitis on CT scans?
Pancreatic Calcification
Pancreatic Duct Dilatation
Pancreatic Pseudocysts
What is ERCP?
It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum
In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken
What is the feature of chronic pancreatitis on ERCP?
A ‘chain of lakes’ appearance of the main pancreatic duct
This indicates that duct has become dilated and tortuous
When is faecal elastase used to investigate chronic pancreatitis?
When imaging scans are inconclusive
What is the faecal elastase test?
It involve measuring the amount of the human pancreas specific enzyme, elastase, is contained within faeces
How is the faecal elastase test used to investigate chronic pancreatitis?
It enables evaluation about the pancreas’s EXOCRINE function and therefore identification of pancreatic insufficiency, which is a complication of chronic pancreatitis
What faecal elastase test result indicates chronic pancreatitis?
Decreased levels of faecal elastase
What are the three conservative management options of chronic pancreatitis?
Alcohol Cessation
Smoking Cessation
Low Fat, High Protein Diet
What are the two pharmacological management options of chronic pancreatitis?
Pancreatic Enzyme Supplementation
Analgesia
Name a pancreatic enzyme supplement
Creon
How are pancreatic enzyme supplements used to manage chronic pancreatitis?
They replace the pancreatic enzymes usually produced by the pancreas to aid digestion of food
This is required due to the chronic inflammation resulting in permanent damage to the pancreas, and therefore dysfunction of endocrine and exocrine function
Name two analgesia drugs used to manage chronic pancreatitis
Codeine
Tramadol
When is analgesia used to manage chronic pancreatitis?
It is used to manage chronic pancreatitis attacks
What are the two surgical management options of chronic pancreatitis?
Partial Pancreatectomy
Total Pancreatotomy
What is partial pancreatectomy?
It involves resection of the inflamed regions of the pancreas
What is total pancreatectomy?
It involves resection of the whole pancreas, as well as the duodenum, common bile duct, gallbladder and spleen
How is pancreatic function restored following total pancreatectomy?
Autologous pancreatic islet cell transplantation (APICT)
What is APICT?
It involves removal of the islet cells, which are responsible for the production of insulin, prior to surgical removal of the pancreas
These cells are then mixed with a special solution and injected into the liver, which enables liver production of insulin
What are the six complications associated with chronic pancreatitis?
Necrotising Pancreatitis
Pancreatic Insufficiency
Pancreatic Pseudocysts
Diabetes Mellitus
Portal Vein/Splenic Thrombosis
Malnutrition
When does diabetes melltius tend to develop in chronic pancreatitis?
It develops > 20 years of symptom onset
