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HPB - Surgery > Chronic Pancreatitis > Flashcards

Chronic Pancreatitis Flashcards

1
Q

What is chronic pancreatitis?

A

An inflammatory condition which can affect both the exocrine and endocrine functions of the pancreas.

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2
Q

What is the pathophysiology & consequences of endocrine insufficiency?

A
  • Pathophysiology = Secondary to damage to the endocrine tissue of the pancreatic gland (islets of Langerhans)
  • Consequence = Subsequent failure to produce insulin, resulting in impaired glucose regulation or eventual diabetes mellitus
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3
Q

What is the pathophysiology & consequence of exocrine insufficiency?

A
  • Pathophysiology - Secondary to damage to the acinar cells
  • Consequence - Failure to produce digestive enzymes, causes malabsorption leading to weight loss, diarrhoea, or steatorrhoea
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4
Q

What are the causes of chronic pancreatitis?

A
  • Alcohol (60%)
  • Idiopathic (30%)
  • Genetics (e.g. CF, haemachromatosis)
  • Ductal obstruction (e.g. gallstones, mass, ductal abnormality)
  • Metabolic (e.g. hyperlipidaemia, hypercalcaemia)
  • Infection
    • Viral (e.g. HIV, mumps, coxsackie)
    • Bacterial (e.g. Echinococcus)
  • Autoimmune (e.g. autoimmune pancreatitis (AIP) or SLE)
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5
Q

What are the risk factors?

A
  • Alcohol
  • Smoking
  • Family Hx
  • Coeliac disease
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6
Q

What are the symptoms?

A
  • Pain
    • Epigastric, dull, radiating to the back, diminished by sitting forwards & worse approximately 30 minutes post-prandially (After a meal)
  • Nausea & Vomiting
  • Weight loss
  • Steatorrhoea (late symptom)
  • Jaundice (rare)
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7
Q

Why does steatorrhea occur?

A

Inflammation and fibrosis of the gland causes injury, atrophy, and loss of pancreatic exocrine tissue, leading to impaired digestion of fats.

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8
Q

What would you typically find on examination?

A
  • Epigastric tenderness possible
  • Cachexia
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9
Q

What bloods would you want to order with high suspision of chronic pancreatitis?

A
  • Blood glucose
  • FBC
  • LFTs
  • Faecal elastase (low)
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10
Q

Why is blood glucose an important investigation to order?

A

Because glucose intolerance is an early occurance due to insulin resistance / insulinopenia

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11
Q

What faecal elastase result would indicate severe disease?

A

< 200 mg/g

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12
Q

What imaging modalities can aide a diagnosis of chronic pancreatitis?

A

1. CT abdo/pelvis

  • More sensitive at detecting pancreatic calcification.
    2. Transabdominal USS of RUQ
  • ONLY IF CT unavailable
    3. Abdominal XR
  • Shows pancreatic calcification in 30% of cases
    4. Endoscopic ultrasound (EUS)
  • May also be used in cases of diagnostic uncertainty.
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13
Q

Give some differential diagnoses.

A
  • Peptic ulcer disease
  • Reflux disease
  • Abdominal aortic aneurysm
  • Biliary colic
  • Chronic mesenteric ischaemia.
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14
Q

What is the management of ongoing chronic pancreatitis?

A
  1. Treat reversible underlying causes
  • Drinking cessation
  • Smoking cessation
  • Statins (for hyperlipidaemic)
  1. Analgesia (neuropathic)
  2. Pancreatic ensyme supplements (Creon)
  3. Vitamin supplements & regular bone density checks
  4. Antioxidants: limited evidence base - one study suggests benefit in early disease
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15
Q

What is the management of acute attacks of chronic pancreatitis?

A
  1. Analgesia (following WHO analgesic ladder)
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16
Q

What can be used to reduce symptoms of chronic pancreatitis caused by an autoimmune problem?

A

Steroids (Prednisolone)

High dose used initially to bring symptoms under control followed by low dose maintenance regime.

17
Q

How do you manage pancreatogenic diabetes?

A

Insulin regime alongside annual HbA1c review

18
Q

When would you manage chronic pancreatitis endoscopically?

A

In cases with a targetable underlying cause.

19
Q

What are the options with endoscopic management of chronic pancreatitis?

A
  • ERCP
    • Used for diagnostic and therapeutic purposes (inc stone removal, stent placement, or sphincterotomy)
  • Endosonography-guided celiac plexus blockade or thoracoscopic splanchnicectomy
    • Performed purely for analgesic purposes.
20
Q

What is the prognosis?

A

Chronic pancreatitis is associated with significant morbidity and reduced quality of life, as it can be a challenging condition to manage effectively.

In some patients, the disease may eventually ‘burn out’ after many years of pain, leaving residual endocrine and exocrine insufficiencies.

21
Q

Why should new / evolving symptoms in a patient with established disease (20+ years) be investigated?

A

Pancreatic malignancy is a risk in those who have had the disease for 20 years or more.

HPB - Surgery (2 decks)

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