Chronic Pancreatitis

Question 1

What is chronic pancreatitis?

Answer 1

Chronic inflammation and fibrosis of both the exocrine and endocrine components of the pancreas.

Question 2

Which parts of the pancreas are affected in chronic pancreatitis?

Answer 2

Both the endocrine and exocrine parts

Question 3

What is the most common cause of chronic pancreatitis?

Answer 3

Chronic alcohol use (80%)
Idiopathic (20%)

Question 4

What are genetic associations with chronic pancreatitis?

Answer 4

Cystic fibrosis

Question 5

What is an obstructive cause of chronic pancreatitis?

Answer 5

Pancreatic cancer

Question 6

What are the main presenting symptoms of chronic pancreatitis?

Answer 6

Epigastric pain, classically worse after eating fatty food and relieved by sitting forward.
Exocrine and endocrine dysfunction

Question 7

How can the epigastric pain be affected in someone with chronic pancreatitis?

Answer 7

Worse after eating
Better on leaning forward

Question 8

What are the possible features of exocrine dysfunction that chronic pancreatitis can present with?

Answer 8

Malabsorption
Steatorrhoea

Question 9

What are the possible features of endocrine dysfunction that chronic pancreatitis can present with?

Answer 9

Type 1 diabetes mellitus
(thirst and polyuria)

Question 10

What imaging can be used to diagnose chronic pancreatitis?

Answer 10

Abdominal x-ray - calcifications
CT scan to show pancreatic calcification

Question 11

Which form of imaging is more specific for chronic pancreatitis?

Answer 11

CT scan
(more sensitive at detecting pancreatic calcification)

Question 12

What will not be raised that is raised in acute pancreatitis?

Answer 12

serum amylase and lipase

Question 13

What test can be done to look at endocrine dysfunction?

Answer 13

Fasting glucose
OGTT test

Question 14

What test caan be done to look at exocrine dysfunction?

Answer 14

Faecal elastase

Question 15

What is conservative management of chronic pancreatitis?

Answer 15

Alcohol abstinence
Good diet

Question 16

What can be used in the medical management of chronic pancreatitis?

Answer 16

pain control with analgesia,
Endocrine dysfunction- insulin
Exocrine dysfunction- pancreatic enzyme replacement.

Question 17

What invasive proceedures can be considered for chronic pancreatitis if other management fails?

Answer 17

Coeliac plexus block
Pancreatectomy.

Question 18

What are the local complications of chronic pancreatitis?

Answer 18

Pseudocyst
Pancreatic cancer

Question 19

What are the main presenting features of Chronic pancreatitis?

Answer 19

• epigastric abdominal pain radiating through to back — Generally worse after meals
• steatorrhoea
• diarrhoea
• diabetes mellitus — occurs >20 years after symptoms begin
• weight loss

Question 20

What else can you look for in the blood?

Answer 20

CA19-9 (pancreatic cancer)
Amylase (normal)
Glucose/HbA1c

Question 21

What does repeated inflammation of the pancreas result in?

Answer 21

Repeated inflammaion of the pancread results in replacement of the acinar cells by fibrotic tissue

Question 22

What might you see on an abdominal x-ray of someone with pancreatitis?

Answer 22

Pancreatic calcification