Chronic Pancreatitis Flashcards
defined based on clinical features (abdominal pain, exocrine insufficiency [steatorrhea], or endocrine insufficiency [diabetes mellitus]) or on imaging techniques including US, CT, EUS, MRI, MRCP, and ERCP
common in men and is most commonly a disease of middle age, with most patients diagnosed above the age of 40.
Chronic pancreatitis
perilobular fibrosis and ductal metaplasia, are also commonly seen in patients of advanced age without chronic pancreatitis, and in patients with long-standing diabetes mellitus
Autoimmune Pancreatitis that is more robust lymphoplasmacytic infiltrate, including plasma cells, is seen and these are usually positive when stained for immunoglobulin G subtype 4 (IgG4)
(Type 1)
Type of Autoimmune Pancreatitis that has idiopathic duct-centric chronic pancreatitis is characterized by neutrophilic infiltration and the absence of IgG4 positive plasma cells.
Type 2
Alcohol Chronic Pancreatitis
at least 5 years (and in most patients more than 10 years) of intake exceeding 4 to 5 drinks per day are required before the development of chronic pancreatitis
common in patients with alcohol-induced chronic pancreatitis,
is associated with an increased risk for pancreatic calcifications,
and smoking cessation after the clinical onset of chronic pancre-
atitis reduces the risk of subsequent calcifications
smoking
more common forms of chronic pancreatitis in certain areas of southwest India, although its incidence is decreasing
Tropical Pancreatitis
a disease of youth and early adulthood, with a mean age at onset of 24 years.
manifests as abdominal pain, severe malnutrition, and exocrine or endocrine insufficiency.
The pathology is characterized by these large intraductal calculi along with marked dilation of the main pancreatic duct and gland atrophy.
The pathophysiology of tropical pa
Tropical Pancreatitis
Lymphoplasmacytic infiltration
Dense periductal infiltrate without damage to ductal epithelium
Storiform fibrosis
Obliterative phlebitis
Abundant (>10 cells/HPF) IgG4-positive cells Fibroinflammatory process may extend to peripancreatic region
Male
60-70 years old
Type 1 AIP
Lymphoplasmacytic and neutrophilic infiltration around ducts
Destruction of duct epithelium by neutrophils (granulocytic epithelial lesion)
Obliterative phlebitis rare No IgG4-positive cells
associated with IBD
Type 2 AIP
type 1 AIP imaging
Typical imaging:
Diffuse enlargement of pancreas with delayed enhancement With or without rim-like enhancement or pancreas
IgG4 >2 × upper limit of normal
Definitive type 1 AIP
Response to steroids(0.6 to 1 mg/kg has been suggested.)
A common starting dose is 40 mg of prednisone daily.
Repeat pancreatic imaging at 2 to 4 weeks is prudent, to assess for clinical and radiographic response.
Relapse in Type 1 AIP
repeat course of glucocorticoids followed by maintenance at a low dose of prednisone (e.g., 5 to 10 mg/day)
Pancreas divisum
Pancreas divisum is a common normal variant, occurring in approximately 4% to 11% of the population
Dysfunction of the sphincter of Oddi, like pancreas divisum, is most often proposed as a cause of acute or recurrent acute pan- creatitis
Predictors of chronic pancreatitis
multiple relapsing attacks, smoking, and alcohol use.
Chronic pancreatitis abdominal pain
Pain is most commonly described as being felt in the epigastrium, often with radiation to the back.
Pain is usually described as boring, deep, and penetrating and is often associated with nausea and vomiting.
Pain may be relieved by sitting forward or leaning forward, by assuming the knee-chest position on one side, or by squatting and clasping the knees to the chest.
Pain may worsen after a meal and often is nocturnal.
