Chronic Pancreatitis

Question 1

What is chronic pancreatitis?

Answer 1

= persistent inflammation of the pancreas that results in permanent structural damage with fibrosis and ductal strictures followed by decline in endo and exocrine function

Question 2

Aetiology of chronic pancreatitis?

Answer 2

50% alcohol (unknown mechanism)
20% idiopathic
Other causes: cystic fibrosis, trauma, hereditary, chronic obstruction by stone, tumour

Question 3

Pathophysiology of chronic pancreatitis

Answer 3

Same hypothesis as acute pancreatitis. An initiating factor causes protein plugs that lead to obstruction in the ductules leading to chronic inflammation and then fibrosis and strictures

Question 4

Compare the intial and later signs and symptoms of chronic pancreatitis

Answer 4

Initially patients present with epigastric abdominal pain that can radiate through to the back (like in acute pancreatitis).

However as the acinar cells are progressively destroyed, less enzymes are produced and the pain disappears.

When lipase and protease secretions are

Question 5

How do we Dx chronic pancreatitis?

Answer 5

• Suspicion on clinical findings
• Bloods: not useful as serum amylase and lipase can be normal late in the disease as exocrine function declines
• AXR: can reveal pancreatic calcification
• CT scan: should be done to rule out pancreatic cancer, also shows the size and texture of pancreas
• Endoscopic retrograde cholangiopancretography (ERCP)
• Pancreatic exocrine function tests

Question 6

How do we manage chronic pancreatitis?

Answer 6

Management:
Similar to acute pancreatitis
	• IV fluid resuscitation
	• Fasting
	• Parenteral analgesics
	• Acid blockers
Addition of: oral pancreatic enzyme supplements and/or insulin as needed