Chronic Pancreatitis Flashcards
How is CP characterised
Irreversible glandular destruction
What does CP typically cause
Pain
Permanent loss of function
Cause
Alcohol CF Congenital Anatomical Abnormalities Hereditary Hypercalcaemia
Genes associated with pancreatitis
PRSS1
SPINK1
CFTR
Mechanisms which lead to CP (pathogenesis)
Obstruction of ducts
Dysfunction of sphincter of Oddi
Abnormal trypsin activation
Pathology of CP
Atrophy of glandular tissue which leads to healing by fibrosis
Dilated, strictured and tortuous ducts
Inspissated (thickened) secretions calcify
Nerves become exposed due to loss of peri-neural cells
Thrombosis of splenic, SMV and portal veins –> PHTN
Clinical Features
Asymptomatic - early disease
Abdo pain (exacerbated by food & alcohol) Weight loss (due to pain and malabsorption)
Jaundice, PHTN, GI haemorrhage, pseudocysts, pancreatic carcinoma
What does insufficiency of the pancreas’ endocrine function lead to
Fat malabsorption –> steatorrhea –> vitamin A, D, E, K and Ca, Mg loss
Protein malabsorption –> Weight Loss & B12 loss
What does insufficiency of the pancreas’ exocrine function lead to
Diabetes
Imaging Investigations
AXR - calcification
USS - size, cysts, ducts, tumour
EUS
CT scan
Blood tests
Increased serum amylase (acute exacerbations)
Decreased albumin, Ca, Mg, Vit B12
Increased LFTs, promthrombin time, glucose
Pancreatic function tests
Management of pain control
Alcohol abstinence Pancreatic enzyme supplements Opiate analgesia Coeliac plexus block Endoscopic treatment for stones & strictures
Management of endocrine and exocrine function
Low fat diet
Pancreatic enzyme supplements
Insulin for diabetes
What can worsen prognosis
Acute on chronic exacerbations Cardiovascular complications Complications of diabetes Cirrhosis Alcohol
