Chronic Pancreatitis

Question 2

Define chronic pancreatitis?

Answer 2

Question 3

What are the main causes and RFs for chronic pancreatitis?

Answer 3

Question 4

What are the chronic inflammatory changes seen in chronic pancreatitis?

Answer 4

Question 5

Describe the pathophysiology of chronic pancreatitis and its sequelae.

Answer 5

Question 6

List the symptoms of chronic pancreatitis.

Answer 6

+ exorine dysfunction => vitamins ADEK and steatorrhoea
+ endocrine dysfunction => diabetes

Question 7

List the signs/ biochemical findings of chronic pancreatitis.

Answer 7

Question 8

List some ddx for chronic pancreatitis.

Answer 8

Question 9

Explain what type of CT is used in dx of chronic pancreatitis.include findings

Answer 9

Question 10

What would expect to find on US abdo in chronic pancreatitis?

Answer 10

Question 11

What would expect to find on MRCP in chronic pancreatitis?

Answer 11

Question 12

What would expect to find on ERCP in chronic pancreatitis?

Answer 12

Question 13

What is the purpose of endoscopic US and aspiration cytology in the context of chronic pancreatitis?

Answer 13

Question 14

Why is faecal elastase measured in chronic pancreatitis and what is the expected result?

Answer 14

Question 15

How would you investigate for chronic pancreatitis?

Answer 15

Question 16

Outline the conservative management of chronic pancreatitis.

Answer 16

Question 17

Outline the medical management of chronic pancreatitis.

Answer 17

Question 18

What is a pancreaticojujunostomy and what is it used for?

Answer 18

Anastamosis of pancreatic duct to the jejunum. It is used to decompress or drain an obstructed pancreatic duct whether it be due to strictures or stones
Also an option post-whipple’s procedure for reconstruction

Question 19

What surgery can be done for pancreatic cancer pain?

Answer 19

Endoscopic-guided celiac plexus blockade or thoracoscopic splanchnicectomy .

Question 20

What procedure is used to treat pancreatic cancer causing chronic pancreatitis? Explain the procedure. Is it a pylorus-preserving proceedure?

Answer 20

Pancreati-co-duodenectomy
2-part procedure: resection + anastomosis
Resection (Removal of Structures):

1) Head of the Pancreas: The primary site of pancreatic cancers.
2) Duodenum
3) Gallbladder
4) Common Bile Duct: Partially or entirely removed.
5) Stomach (partially): In the classic Whipple’s procedure, part of the stomach (pylorus) is removed. In the pylorus-preserving Whipple’s, the pylorus is spared.

Reconstruction (Anastomoses): 3 options

1) Pancreaticojejunostomy: pancreatic duct to jejunum
2) Hepaticojejunostomy: Connecting the remaining bile duct to the jejunum to restore bile flow for fat digestion.
3) Gastrojejunostomy: Connecting the stomach (or pylorus, if preserved) to the jejunum to enable food to pass from the stomach to the intestines.

Question 21

What is the removed in a partial pancreatectomy?

Answer 21

to remove tail ± body of pancreas.

Question 22

What is the most common indication for surgical management in chronic pancreatitis?
Outline the surgical management options of chronic pancreatitis.

Answer 22

Surgical management only if:
1. failed medical therapy or
2. in the case of intractable pain (most common)

Updated options:
Stones/obstruction -> ERCP (stone removal or stent) -> Pancreaticojejunostomy
Head of pancreas -> Whipples/pancreaticoduodenectomy
Body/tail of pancreas -> partial pancreatectomy

Question 23

Outline the FULL management of chronic pancreatitis.

Answer 23

Question 24

Is pancreatic cancer a cause or a complication of chronic pancreatitis?

Answer 24

Both