Chronic pancreatitis

Question 1

Causes

Answer 1

OAC TIGER
Obstruction
Autoimmune
CF

Toxins e.g. alcohol 
Idiopathic 
Genetic 
Environmental 
Recurrent injury 

or CONGENITIAL: annular pancreatic divisum where the pancreatic buds fail to fuse

Question 2

Pathology

Answer 2

-Inflammation leads to obstruction
-Increase in intra-pancreatic pressure leads to:
1-ducts- become dilated, torturous, strictured
2-interferes with nerves- exposure
3- decrease in glandular function- atrophy and fibrosis
4-splenic/ superior mesenteric and portal veins thrombose -increase in portal hypertension

Question 3

Symptoms

Answer 3

Initially asymptomatic

• Abdominal pain exacerbated by food/drink
• Steatorea-related to malabsorption
• Exocrine disfunction= fewer enzymes
• Endocrine dysfunction- diabetes
• Weight loss

Less common:

• Portal hypertension
• Jaundice
• GI hemorage
• Pseudocysts

Question 4

Investigation

Answer 4

Bloods:
CRP>150 is very important 
disregard amylase- more for acute 
Faecal elastase low 
CT/XR for calcification 
US

Question 5

Treatment

Answer 5

Pancreatic enzymes and vitamins 
Surgery:
-Pancretic Duct sphincterectomy: reopens 
-Cystectomy- removes gallstones
-CBD stenting
-Caeliac block plexus - injection to remove pain 
-Drainage
-Resection

Question 6

Management when too advanced

Answer 6

• Pain control
• hormonal management
• surgery if required

Question 7

hereditary cause of chronic pancreatitis?

Answer 7

Cerebral palsy.

Autosomal dominant

Question 8

Environmental cause of chronic pancreatitis?

Answer 8

Tropical chronic pancreatitis

Question 9

What causes recurrent pancreatic injury?

Answer 9

hyperlipidemia and hypercalcemia

Question 10

What does US show?

Answer 10

large pancreas
cysts
duct diameter tumours

Question 11

Pain control

Answer 11

• Avoid alcohol
• Opiate
• Clinic referral
• Remove pancreatic duct stones
• coeliac plexus block- injections for pain- compresses the plexus to prevents pain

Question 12

How are hormonal defects managed?

Answer 12

Pancreatic duct supplements

Low fat diet

Question 13

When is surgery performed?

Answer 13

• malignancy
• Duct/duodenal stenosis
• Biliary obstruction
• Colonic stricture
• Pseudocyst
• Thrombosis of gastric varices
• Compression of portal vein

Question 14

Surgery performed?

Answer 14

• CBD stenting/ bypass
• Cyst drainage
• Resection
• Thorascopic splanchectomy
• Endoscopic sphincterectomy