Chronic pancreatitis Flashcards
1
Q
What is chronic pancreatitis
A
-Irreversible damage to pancreas through inflammation (reversible damage in acute pancreatitis)
2
Q
How common is it
A
3 in 100,000 in UK
3
Q
Who is affected
A
4:1 M>F
4
Q
What causes chronic pancreatitis
A
- Alcohol
- Pancreatic duct obstructiobn (stone/tumour)
- Hyperparathyroidism (hypercalcaemia)
- Epigenetic (=heritable variations in gene expression) deregulation
- Haemochromatosis
- CF (in almost all)
5
Q
What is the pathophysiology of alcohol related chronic pancreatitis
A
- Alcohol –> precipitation proteins into ductular structure (pancreas) –> local dilation + fibrosis
6
Q
What are the symptoms of chronic pancreatitis
A
- Epigastric pain (radiate to back) –> relieved by sitting forward
- Steatorrhoea (malabsorption fat due to reduced lipase prod)
- Weight loss - malabsorption
7
Q
What are the signs of chronic pancreatitis
A
- Erythema ab igne - looks like LT exposure to heat
8
Q
What are the differential diagnoses
A
- pancreatic cancer
- acute pancreatitis
- biliary colic
- peptic ulcer disease
- IBS
- AAA
9
Q
What investigations would you perform
A
- BLOODS - lipase/amylase, FBC/ U&E/ CRP, glucose
- USS - biliary stones, dilated biliary tree
- if normal consider CT, ERCP
10
Q
What are some of the complications that can arise from chronic pancreatitis
A
- Diabetes (bc the pancreas produces insulin)
- pseudocyst + biliary obstruction
11
Q
What is the management for chronic pancreatitis
A
- Analgesia
- Lipase (e.g. Creon)
- Fat soluble vitamins (multivit)
- Low fat diet, no alcohol
- Surgery - drainage or resection
- insulin for diabetes
