chronic pancreatitis

Question 1

what is it?

Answer 1

irreversible parenchymal atrophy and fibrosis leading to impaired endocrine and exocrine function and recurrent abdominal pain.

Question 2

aetiology?

Answer 2

ALCOHOL - 70%

Idiopathic - 20%

Question 3

Most commonly associated with?

Answer 3

chronic alcohol ingestion (>75%).

Question 4

Hallmark features are?

Answer 4

epigastric abdominal pain radiating to the back

steatorrhoea - excretion of abnormal amount of fat with faeces

malnutrition

diabetes mellitus.

Question 5

Difference between acute and chronic pancreatitis?

Answer 5

Acute pancreatitis is a self-limiting and reversible pancreatic injury associated with mid-epigastric abdominal pain and elevated serum pancreatic enzymes, whereas;

chronic pancreatitis is characterised by recurrent or persistent abdominal pain and progressive injury to the pancreas and surrounding structures, resulting in scarring and loss of function.

becareful not to confuse reccurent acute pancreatitis for chronic

Question 6

Presenting symptoms?

Answer 6

Pain is epigastric, dull, radiating to the back, diminished by sitting forwards,
Worse approximately 30 minutes post-prandially - after eating
Steatorrhea
weight loss, malnutrition
nausea, vomiting

sometimes;
jaundice
SOB
joint pain
abdo distension

Question 7

risk factors?

Answer 7

alcohol
smoking
coeliac disease
FH
psoriasis
high fat high protein diet

Question 8

signs?

Answer 8

epigastric tenderness

Question 9

ivx?

Answer 9

blood glucose - elevated

abdo ct or MRI - pancreatic calcifications, focal or diffuse enlargement of the pancreas, ductal dilation, and/or vascular complications

others;
feacal elastase1 - low (if severe)
igG4 - positive in autoimmune pancreatitis
biopsy - increased connective tissue, loss of acini, inflammation

abdo us - calcifications, structure changes
abdo xray - calcifications

MRCP - beading of main pancreatic duct, others abnormal

Question 10

Treatment?

Answer 10

acute episodic pain;
ibuprofen or paracetmol AND tramadol
later escalated to stronger analgesics if necessary

chronic pain;
stop smoking and drinking
analgesics
pancreatic enzymes (pancreatin) + PPI (omeprazole)

Question 11

Treatment if intractable pain and calcifications?

Answer 11

ESWL

extracorporeal shockwave lithotripsy