CHRONIC PANCREATITIS Flashcards
What are the majority of cases of chronic pancreatitis due to?
High consumption of ethanol
What are the causes of chronic pancreatitis?
Chronic alcohol abuse Repeated stones Cystic fibrosis Hyperparathyroidism (hypercalcaemia) Haemochromatosis Smoking Recurrent episodes of acute pancreatitis
What are the changes to the pancreas that occur in chronic pancreatitis?
Protein deposition along the pancreatic duct which leads to duct dilatation. This is followed by acinar atrophy and fibrosis around the pancreatic ducts. Calcification of the protein plugs occurs.
What are the clinical features of chronic pancreatitis?
Chronic epigastric/upper abdominal pain usually radiating to the back
Pain is precipitated by heavy alcohol consumption
Steatorrhoea and malabsorption
Weight loss
What investigations would you do in someone who presents with the signs and symptoms of chronic pancreatitis?
Serum amylase FBC LFTs Abdominal x-ray Abdominal CT ERCP
What would blood tests in someone with chronic pancreatitis typically show?
Amylase is not usually raised in chronic pancreatitis unless it is an acute attack.
High glucose due to secondary diabetes
Macrocytic anaemia (malabsorption does not affect iron as much as B12 and folate)
LFTs often reflects high alcohol consumption - Raised GGT, Ratio of AST:ALT of over 2, Low albumin
What might you see on an abdominal CT or X-ray of someone with chronic pancreatitis?
X-ray - Pancreatic calcification
CT - Pancreatic swelling or pseudocysts
What might ERCP reveal in someone with chronic pancreatitis?
Distorted and irregular pancreatic ducts indicative of fibrosis
What are the complications of chronic pancreatitis?
Pain - significant proportion will end up dependent on opiates
Malabsorption - reduced secretion of lipase means steatorrhoea and fat soluble vitamin deficiencies
Diabetes - requires insulin treatment
Pseudocysts - painful
Jaundice - rare, occurs with ascending cholangitis
Portal hypertension - thrombosis of portal or splenic vein.
What do we call continuing intermittent attacks of acute pancreatitis on a background of chronic pancreatitis?
Chronic relapsing pancreatitis
What is the main differential in someone who presents with signs and symptoms consistent with chronic pancreatitis?
Cancer of the pancreas
How is someone with chronic pancreatitis managed?
The patient needs to stop drinking altogether
Pain control
Pancreatic enzyme supplementation
Treatment of diabetes - normally with insulin
Surgery - removal of pancreatic stones or occasional complete pancreatectomy.
Coeliac ganglion blockade - no effect on continued inflammation.
