Chronic Pancreatitis

Question 1

What is Chronic Pancreatitis?

Answer 1

Chronic, irreversible changes as a result of inflammation and/or fibrosis of the pancreas

This condition involves long-term damage leading to functional impairment of the pancreas.

Question 2

What are the key components of the pathophysiology of Chronic Pancreatitis?

Answer 2

• Recurrent episodes of acute pancreatitis
• Causes fibrosis & dilatations/calcification of pancreatic duct and branches
• Effects islets of Langerhans –> failure to produce insulin
• Effects acinar cells –> failure to produce enzymes

Question 3

What is the primary cause of Chronic Pancreatitis?

Answer 3

• Alcohol (70%)
• Idiopathic (25%)

Question 4

What are some risk factors for Chronic Pancreatitis?

Answer 4

* Alcohol
* Smoking
* AI and genetic conditions: CF
* Drugs: Thiazides
* Obstructive causes - gallstones
* Tropical chronic pancreatitis

Question 5

What are the common symptoms of Chronic Pancreatitis?

Answer 5

• Severe epigastric/LUQ pain, radiates to back
• Nausea/Vomiting
• Anorexia
• Endocrine dysfunction (diabetes)
• Exocrine dysfunction (malabsorption, weight loss, diarrhoea, steatorrhea)

Question 6

What is the Chronic Pancreatitis TRIAD?

Answer 6

• Pancreatic calcifications on CT
• Steatorrhea
• Diabetes Mellitus

Question 7

What blood tests are typically involved in the investigation of Chronic Pancreatitis?

Answer 7

• FBC
• U&E
• Creatinine
• LFTs
• Ca, Mg
• ** Amylase (usually normal)**
• Glucose and HbA1C
• Serum trypsinogen (if malabsorption present)
• Faecal elastase - pancreatic exocrine function

Question 8

What is the gold standard diagnosis imaging for Chronic Pancreatitis?

Answer 8

CT with IV contrast: calcification, atrophy or duct dilation

This imaging method provides the most definitive visual assessment of the pancreatic condition.

Question 9

What are alternative imaging methods for diagnosing Chronic Pancreatitis?

Answer 9

• ERCP
• (secretin enhanced) MRCP - less invasive
• Endoscopic Ultrasounds (EUS) - most sensitive

Question 10

What are the management strategies for Chronic Pancreatitis?

Answer 10

• Analgesia: ‘Ladder’, coeliac plexus block
• Pancreatic enzyme replacement (e.g. Creon)
• MDT approach: dietitian, diabetes, gastro teams
• Smoking/Alcohol cessation
• Surgery

Question 11

What are potential complications of Chronic Pancreatitis?

Answer 11

• Pancreatic pseudocyst and necrosis
• Bile duct/deuodenal obstruction
• Local aneurysm
• Splenic vein thrombosis
• Pancreatic cancer