chronic pancreatitis Flashcards
What is chronic pancreatitis?
Persistent inflammation of the pancreas causing irreversible fibrosis, destruction, and calcification, impairing both endocrine and exocrine functions.
What is the most common cause of chronic pancreatitis?
Chronic alcoholism (accounts for ~70% of cases).
What are other causes of chronic pancreatitis?
Cystic fibrosis (CF), idiopathic, and congenital pancreatic anomalies.
What are the typical symptoms of chronic pancreatitis?
• Severe epigastric pain, often radiating to the back
• Recurrent or persistent, worsened by eating or alcohol
• Nausea and vomiting
What are signs of exocrine insufficiency in chronic pancreatitis?
Fat malabsorption, leading to steatorrhea and weight loss.
What are signs of endocrine insufficiency in chronic pancreatitis?
Glucose intolerance and diabetes mellitus (polyuria, polydipsia).
What are complications of chronic pancreatitis?
• Narcotic addiction
• Diabetes mellitus
• Vitamin B12 deficiency
• Splenic vein thrombosis (gastric varices)
• Pseudocyst formation
• CBD obstruction
• Pancreatic carcinoma risk (~2%)
Why are labs not very useful in diagnosing chronic pancreatitis?
Because amylase and lipase are often normal in chronic cases.
What is the role of 72-hour fecal fat analysis in chronic pancreatitis?
The 72-hour fecal fat analysis is a gold standard diagnostic test to assess fat malabsorption (steatorrhea), which is a hallmark of exocrine pancreatic insufficiency (EPI) seen in chronic pancreatitis.
What is the purpose of the secretin stimulation test?
To assess the exocrine functional reserve of the pancreas by measuring response to secretin.
• Secretin is a hormone released from the duodenum in response to acid from the stomach. • It stimulates the pancreas to secrete a bicarbonate-rich fluid via the pancreatic ducts.
What is the best imaging method for diagnosing chronic pancreatitis?
CT scan (shows pancreatic calcifications), though mild cases may still be missed.
What imaging alternatives are used if CT is inconclusive?
• MRCP (non-invasive)
• ERCP (gold standard but invasive and not routinely done)
What are the key components of nonoperative management of chronic pancreatitis?
• Lifestyle changes: Alcohol cessation, small frequent low-fat meals
• Pain control: Narcotic (opioid) analgesics
• Pancreatic enzymes & H2 blockers (given together)
• Insulin therapy if diabetes develops
How do pancreatic enzymes and H2 blockers work in chronic pancreatitis management?
• Pancreatic enzymes inhibit CCK release, reducing pancreatic stimulation
• H2 blockers reduce gastric acid secretion, preserving enzyme activity
When is surgery indicated in chronic pancreatitis?
• Persistent pain
• Biliary obstruction
• Complicated pseudocysts
• Celiac plexus block (for pain relief)
• Refractory cases requiring drainage or resection
What are the surgical options for chronic pancreatitis?
• Pancreaticojejunostomy (most common)
• Pancreatic resection (e.g., distal pancreatectomy, Whipple procedure)
What is the most common type of pancreatic cancer?
Adenocarcinoma from the exocrine pancreas.
Where do most pancreatic cancers occur?
In the head of the pancreas (about 2/3 of cases).
Why is cancer in the pancreatic head usually diagnosed earlier?
Because it causes early biliary obstruction, leading to painless jaundice.
What are the main risk factors for pancreatic cancer?
• Smoking (3x increased risk)
• Alcohol use
• Chronic pancreatitis
• Diabetes mellitus
What are key symptoms of pancreatic cancer?
• Weight loss (90%)
• Chronic epigastric pain (75%)
• Painless jaundice
• Gastric outlet obstruction (non-bilious vomiting, early satiety)
What are classic clinical signs of pancreatic cancer?
• Courvoisier’s sign (palpable, painless gallbladder)
• Trousseau’s syndrome (migratory thrombophlebitis)
• Splenomegaly & ascites
• Virchow’s node, Sister Mary Joseph nodule
What tumor markers are associated with pancreatic cancer?
CEA and CA 19-9
What imaging is used to diagnose pancreatic cancer?
• CT with contrast: may show the double duct sign
• ERCP with biopsy: especially if peri-ampullary tumor
