Chronic pancreatitis

Question 1

What the main changes would you see in chronic pancreatitis?

Answer 1

fibrosis, destruction of exocrine tissue, and endocrine tissue eventually.

Question 2

What is the main difference between acute and chronic pancreatitis?

Answer 2

Acute pancreatitis will have normal histological and functional findings eventually. Chronic pancreatitis is permanent

Question 3

What do you see pathologically in chronic pancreatitis?

Answer 3

A patchy, focal disease with PMNs and fibrosis

Question 4

What do you see pathologically in acute pancreatitis?

Answer 4

Diffuse PMN inflammatory response

Question 5

What is the most common cause of chronic pancreatitis?

Answer 5

Alcohol abuse

Question 6

What are other causes of chronic pancreatitis?

Answer 6

1. idiopatic
2. hereditary
3. CF
   Autoimmune
   Ductal obstruction
   Tropical pancreatitis
   Hyperparathyroidism

Question 7

What types of patients get idiopathic pancreatitis?

Answer 7

1. Young females (age 19)

2. Older males (age 56)

Question 8

How is hereditary pancreatitis inherited?

Answer 8

Autosomal dominant

Question 9

What is the main risk with hereditary pancreatitis?

Answer 9

Pancreatic cancer. 40% develop pancreatic cancer by age 70.

Question 10

What mutations are seen in hereditary pancreatitis?

Answer 10

Mutation preventing the inactivation of trypsin.
Excess of trypsin activity and pancreatitis
R117H mutation on chromosome 7

Question 11

What is different about the pancreatitis in CF?

Answer 11

usually no painful attacks, only exocrine insufficiency. Failure to thrive and malabsorption

Question 12

What kind of antibody is seen in autoimmune pancreatitis?

Answer 12

IgG4

Question 13

How do you treat autoimmne pancreatitis?

Answer 13

Corticosteroid therapy

Question 14

What does tropical pancreatitis look like?What is the cause?

Answer 14

Calcific pancreatitis. NOT SEEN in the US> thought to have something to do with protein malnutrition

Question 15

How does chronic pancreatitis present?

Answer 15

Abdominal pain–>anorexia and weight loss
Pain brought on by eating and radiating to the back. Discrete attacks progressing to continuous pain.

OR, can present with no pain but only pancreatic exocrine or endocrine dysfunction

Question 16

What are the exocrine functional losses in pancreatitis?

Answer 16

Lipase=steatorrhea
Trypsin loss=azotorrhea
Malabsorption of vitamins
Note that 90% of cells must be lost

Question 17

What are the endocrine functional losses in pancreatitis?

Answer 17

insulin and glucagon no longer produced. Difficult to treat.

Question 18

What is the best imaging test to first evaluate chronic pancreatitis?

Answer 18

CT scan

Question 19

What can a CT scan tell you?

Answer 19

ductal abnormalities
pancreatic calcification
pseudocysts

Question 20

what is the most sensitive imaging test in chronic pancreatitis?

Answer 20

Endoscopic ultrasound: earlier detection

Question 21

Why should you not use ERCP?

Answer 21

It can cause acute pancreatitis

Question 22

What are tests of pancreatic function?

Answer 22

Secretin fxn test measures output of pancreas. NOT OFTEN USED

Question 23

What are the compications of chronic pancreatitis?

Answer 23

1. Chronic pain
   
   2. Steatorrhea (fat malabsorption), malnutrition, weight loss
   3. Diabetes mellitus
   4. Pancreatic ascites or pleural effusion
   5. Pseudocyst
   6. Splenic vein thrombosis
   7. Duodenal obstruction
   8. Common bile duct obstruction

Question 24

How do you treat chronic pancreatitis?

Answer 24

1. stop alcohol
2. analgesics
3. Exogenous pancreatic enzymes if needed
4. Insulin if diabetic
5. Direct nerve blocks
6. Oral pancreatic enzymes if needed

Question 25

What can splenic vein thrombosis lead to?

Answer 25

Esophageal varices

Question 26

Pancreatic pseudocysts

Answer 26

Wall of granulation tissue from liquefied pancreas. Seen in chronic pancreatitis. Requires drainage. No epithelial layer.