Chronic Pancreatitis Flashcards
What is chronic pancreatitis?
Irreversible inflammatory changes to the pancreas parenchyma causing reduced pancreatic function.
What are some common causes of chronic pancreatitis?
- Alcohol
- Idiopathic
- Cystic Fibrosis
- a1 anti-trypsin deficiency
- Tumour
- Hyperparathyroidism
- Haemochromatosis
What is the pathophysiology of chronic pancreatitis?
Recurrent episodes of acute pancreatitis causing irreverisible changes in the pancreatic tissue - atrophy and calcification
This leads to reduced exocrine and endocrine function
Why is there pain in chronic pancreatitis?
Recurrent episodes of pain lasting a few hours at a time, due to raised intraductal pressures
How might a patient with chronic pancreatitis present?
- Recurrent episodes of epigastric pain lasting a few hours at a time - relieved by sitting forwards, worse on eating/binge drinking
- Steatorrhea
- Weight loss
- Polyuria and polydipsia
Why do patients with chronic pancreatitis have steatorrhea and weight loss?
Due to loss of pancreatic function, patients aren’t able to absorb fats
- Fat not absorbed -> excreted in stool
How would you investigate a patient with chronic pancreatitis?
BLOODS - serum amylase and lipase not raised; hyperglycaemia
IMAGING -X-ray/CT will show calcification and atrophy
Duct visualistation using ERCP or MRCP – may show ‘chain of lakes’ appearance
Why do you get a ‘chain of lakes’ appearance on ERCP or MRCP imaging of the duct?
Due to strictures with alternating dilatation pattern in the duct.
How would you manage a patient with chronic pancreatitis?
- Analgesia
- Alcohol abstinence
- Insulin
- Vitamins ADEK supplements
- If medical management fails, can indicate surgery e.g. proximal resection
What are some complications of chronic pancreatitis?
- Diabetes mellitus
- Pancreatic pseudocyst/ascites/carcinoma
- Duodenal obstruction
By how much is life expectancy reduced in a patient with chronic pancreatitis?
10-20y
