Chronic pancreatitis

Question 1

What is the most common cause of chronic pancreatitis?

Answer 1

Alcohol

Question 2

What are the causes of chronic pancreatitis?

Answer 2

Alcohol
Cystic fibrosis
Haemochromatosis
Ductal obstruction
- Tumours
- Stones
Autoimmune pancreatitis

Question 3

What are the symptoms of chronic pancreatitis?

Answer 3

Epigastric pain - radiates to back, improved by leaning forwards
Steatorrhoea and diarrhoea
Nausea and vomiting
Weight loss
Fatigue
Features of diabetes
- Polyuria
- Polydipsia

Question 4

What are the clinical signs of chronic pancreatitis?

Answer 4

Epigastric tenderness
Signs of liver disease
Skin nodules

Question 5

What investigations are used in the diagnosis of chronic pancreatitis?

Answer 5

First line - CT abdomen

LFTs - will be abnormal if co-existent liver disease
HbA1c - reduced endocrine dysfunction
Faecal elastase
IgG4 - associated with autoimmune chronic pancreatitis

Question 6

What might a CT abdomen show in chronic pancreatitis?

Answer 6

Pancreatic calcifications
Pancreatic atrophy
Duct dilatation

Question 7

What is the first line management of chronic pancreatitis?

Answer 7

Lifestyle modifications
Diet - low fat, high calorie diet
Fat soluble vitamin supplementation
Analgesia
Pancreatic enzyme replacement - Creon

Question 8

What is the second line management of chronic pancreatitis?

Answer 8

Endoscopic stenting
Coeliac plexus nerve blocks - pain management
Drainage of pseudocysts

Question 9

What are the complications of chronic pancreatitis?

Answer 9

Malabsorption
Duct obstruction
Pseudocysts
Diabetes mellitus
Pancreatic cancer