Chronic pancreatitis

Question 1

Around 80% of cases of chronic pancreatitis are due to ?

Answer 1

alcohol excess with up to 20% of cases being unexplained - previous multiple episodes of acute pancreatitis

Question 2

Other than alcohol, causes include:

Answer 2

cystic fibrosis, haemochromatosis

ductal obstruction:
tumours,
stones,
structural abnormalities including pancreas divisum and annular pancreas

Question 3

clinical features of chronic pancreatitis ?

Answer 3

pain worse 15 to 30 minutes following a meal

steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain

diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin

Question 4

investigation of choice

Answer 4

if obstructive such as UE and LFT shows then abdominal ultrasound

CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%

Question 5

if CT is inconclusive in chronic pancreatitis what can be used ?

Answer 5

faecal elastase may be used to assess exocrine function if imaging inconclusive

Question 6

Blood tests are shown below.

Answer 6

normal serum markers associated with acute presentations are often normal - amylase and bilirubin and AST normal