Chronic Pancreatitis

Question 1

what is chronic pancreatitis?

Answer 1

an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring

Question 2

What are the TIGAR-O risk factors for chronic pancreatitis?

Answer 2

Toxic-metabolic – alcoholism in adults
Idiopathic
Genetic
Autoimmune – CF and anatomic abnormalities in children
Recurrent and severe acute pancreatitis
Obstructive

Question 3

What is the two-hit hypothesis for chronic pancreatitis?

Answer 3

1. have acute pancreatitis which results in pancreas injury
2. abnormal inflammatory response to injury results in sustained activation of pancreatic profibrotic cells

Question 4

What are some s/s of chronic pancreatitis?

Answer 4

1. recurrent acute pancreatitis?
2. losing pancreas exocrine function (steatorrhea, malabsorption, fat-soluble vitamin deficiencies)
3. losing pancreas endocrine function (DM)
4. epigastric pain radiating to back

Question 5

What ix would you order for chronic pancreatitis?

Answer 5

1. first choice would be a contrast CT, would do monitoring and repeat imaging every 6M-1Y ➔ may see calcification
2. bloodwork ➔ targeted to finding underlying etiology and get baseline
3. pancreatic fxn tests
   - fecal elastase

Question 6

is there a gold standard to dx chronic pancreatitis?

Answer 6

no gold standard test, testing is aimed towards the clinical presentation and history

Question 7

How would you treat/manage chronic pancreatitis?

Answer 7

1. pt education on eliminating alcohol and smoking
2. medicinal therapy ➔ pain management, nerve blocks, insulin, low fat diet, pancreatic enzyme replacement, supplements
3. endoscopic treatments ➔ for stones to remove or put in a stent for pain, could also consider draining any cysts that develop
4. surgery ➔ to decompress if abnormalities are showing up on scans