Chronic pancreatitis

Question 1

What causes chronic pancreatitis?

Answer 1

alcohol consumption (most common)
Smoking and genetic

Question 2

How long does it take to develop pancreatic insufficiency?

Answer 2

approx. 10 years

Question 3

What is chronic pancreatitis?

Answer 3

Chronic pancreatitis is characterised by inflammation, fibrosis, and loss of exocrine (acinar cells) and endocrine (islets) tissue

Question 4

How do patients with chronic pancreatitis present?

Answer 4

Present with relapsing acute pancreatitis, chronic or recurrent pancreatic type pain 
Exocrine insufficiency (steatorrhea) and endocrine insufficiency are later consequences

Question 5

How to diagnose early chronic pancreatitis?

Answer 5

CF:
Acute relapsing pancreatitis
Chronic or recurrent pain

Diagnostic testing:
Endoscopic US
Secretin- MRCP
Pancreatic function tests

Therapy

• Medical therapy for pain
• Avoid toxins

Analgesics (tramadol)
Gabapentoids, SSRIs or TCA

Question 6

Diagnosing and Treating Late Chronic Pancreatitis

Answer 6

• Chronic or recurrent pain
• Pancreatic Exocrine Insufficiency (PEI)
• Pancreatogenic diabetes
• Secondary Pancreatic Ca

Diagnostic testing

• CT diagnostic
• MRI/MRCP
• Faecal Elastase for PEI
• HbA1C for DM

Therapy 
- pain 
Endoscopic or surgical therapy for pain 
-dilated duct
Enzyme replacement
- Add vit D and Calcium 
Therapy for DM