Chronic Pancreatitis Flashcards
Define
Chronic inflammatory disease of the pancreas characterised by irreversible parenchymal atrophy and fibrosis leading to impaired endocrine and exocrine function and recurrent abdominal pain
Aetiology/Risk factors
Alcohol (70%), Idiopathic in 20%
70% alcohol
Rare: Recurrent acute pancreatitis, ductal obstruction, pancreas divisum, hereditary pancreatitis, tropical pancreatitis, autoimmune pancreatitis, hyperparathyroidism, hypertiglycidaemia
Epidemiology
Mean age- 40-50 years in alcohol-associated disease
1/100000, Annual UK incidence
Symptoms
Recurrent severe epigastric pain, radiating to back, relieved by sitting forward, can be exacerbated by eating or drinking alcohol
- Over many years, weight loss, bloating and pale offensive stools (steatorrhoea)
Signs
Epigastric tenderness
- Signs of complications e.g. weight loss, malnutrition
Investigations
- Blood: Glucose (increase indicates endocrine dysfunction, glucose tolerance test. Raised immunoglobulins, especially IgG4 in autoimmune pancreatitis
- USS: percutaneous or endoscopic, can show hyperechoic foci with post-acoustic shadowing
- ERCP or MRCP: Early changes include main duct dilatation and stumping of branches. Late manifestations are duct strictures with alternating dilatation
- AXR: Pancreatic calcification may be visible
- CT: Pancreatic cysts, calcification
- Tests of pancreatic exocrine function: FAECAL ELASTASE
Management
General: Mainly symptomatic and supportive tx, e.g. dietary, abstinence from alcohol and smoking, treatment of diabetes, oral pancreatic enzyme replacements
- Endoscopic therapy: Sphincterotomy, stone extraction, dilatation or stenting of strictures
- Surgical: May be indicated if medical management has failed. Later pancreaticojejunal drainage, resection or limited resection of the pancreatic head
Complications
- Psuedocytsts
- Biliary duct stricture
- Duodenal obstruction
- Pancreatic ascites
- Pancreatic carcinoma
