Chronic Pancreatitis Flashcards
What is chronic pancreatitis
Irreversible progressive destruction of the pancreas resulting in progressive fibrosis of the pancreas
Symptoms
Epigastric pain Radiates the the back and the left shoulder relieved by sitting forward and jack knife position on side with knees to the chest Nausea Weightloss Malnutrition Progressive pancreatic insufficiency Steatorrhoea (exocrine) Pale bulky, smelly, oily, stools hard to flush Diabetes (endocrine)
Causes
Toxic metabolic -smoking -alcohol -hypercalcaemia -hyperlipidaemia - renal failure - drugs Autoimmune pancreatitis Hereditary Obstructive - stone -cancer -sphincter of oddi dysfunction
Tests
AXR - calcification CT - parenchyma + duct architecture ERCP/MRCP- ducts EUS- diagnostic can do a FNA suspect cancer Therapeutic coeliac plexus block Fecal elastase
Treatment
Conservative
Stop offensive agent if one, no alcohol, stop smoking, stop drugs, low fat diet may help
Lipase/creon supplement
Medical
Pain relief - opioids, coeliac plexus block
Treat diabetes insulin
Surgical
Non dilated duct resection, whipples, pancreatic duodencetomy, distal pancreatectomy
Dilated ducts - drain - pancreatico-jejunostomy
Complications
Malabsorption Diabetes Duodenal obstruction Biliary obstruction Chronic pseudocyst Splenic vein thrombosis GI bleed/ varices Pancreatic ascites Pancreatic cancer Pseudoaneursym
What is a pseudo cyst
A collection of fluid rich in pancreatic enzymes, blood and necrotic tissue enclosed in fibrous or granulation tissue
When do you treat a pseudo cyst
Symptoms
Complications
Bigger than 6cm
How to treat malabsorption
Creon, supplements
How to treat diabetes
Insulin
Be aware no glucagon either
Hypos
Treat duodenal obstruction
Duodenaljejunectomy
Gastro jejunectomy
Treat biliary obstruction.
Biliary stenting
Reconstruction
Treat chronic pseudocysts
Drain or remove surgery
Percutaneous or endoscopic drain
Treat pancreatic acscites
Paracentisis
Pancreatic cancer treatment
Palliative
Whipples
