Chronic Pancreatitis

Question 1

What is chronic pancreatitis?

Answer 1

3+ month history of pancreatic deterioration, irreversible pancreatic inflammation and fibrosis

Question 2

What can cause chronic pancreatitis?

Answer 2

Alcohol
CKD (In CKD have increased GI hormones which stimulate hypersection of pancreatic hormones)
CF (mucous obstruction)
Trauma
Recurrent acute pancreatitis

Question 3

What are symptoms of chronic pancreatitis?

Answer 3

Epigastric pain radiating to back, exacerbated by alcohol

Exocrine dysfunction (eg lack of lipase into GI causing steatorrhea)
Endocrine dysfunction (eg lack of insulin causing T2DM)

Damage and strictures to duct system

Pseudocysts or abscess formation

Question 4

How do you diagnose chronic pancreatitis?

Answer 4

Bloods:
Unlikely to have elevated amylase and lipase because such a deficiency that none left to leak into blood

Faecal elastase (good indicator of exocrine function, so low in chronic pancreatitis)

Abdominal USS and CCT:
Detects pancreatic calcification and dilated pancreatic ducts (diagnostic)

Question 5

What is treatment for chronic pancreatitis?

Answer 5

Alcohol cessation
NSAIDs for abdominal pain
Pancreatic supplements including enzymes and insulin for DM

Question 6

Name some potential diagnoses for epigastric pain radiating to back

Answer 6

Pancreatic cancer
Acute pancreatitis
Chronic pancreatitis
AAA