Chronic pancreatitis Flashcards
Define chronic pancreatitis
Irreversible parenchymal atrophy and fibrosis leading to impaired endorine and exocrine function and recurrnet abod pain
Causes
Alcohol = 70% Smoking Idiopathic 20% Recurrent acute pancreatitis Hereditary causes
What causes the pain?
Raised intraductal pressures
Epidemolgoy
mean age - 40-50
rarer 1/10 000
Symptoms
Recurrent severe epigastric pain
Radiates to the back
Pain aggravated by eating or drinking alcohol
Weight loss
Bloating
Steatorrhoea (due to flow of bile is obstructed)
Pain relieved by sitting forward
Signs
Epigastric tenderness
Weightloss
Malnutrition
Ultra
Bloods Ultrasound ERCP / MRCP Abdo XR CT scan Fecal elastase
Bloods
High glucose
Amylase and lipase are NORMAL
High Ig (especially IgG4 in autoimmune pancreatitis)
What would imaging of the abdo region show?
Soponification in pancrease
What would the ERCP or MCRP show?
Bile duct strictures
What would foecal elastase test show?
High foecal elastase due to not much exocrine function?
Management
Stop drinking and smoking Treat diabetes Oral pancreatic enzyme replacement Analgesia Dietary advice (low fat) Endoscopy therapy Surgical
Complications - local
Pseudocysts Biliary duct stricture Duodenal obstruction Pancreatic ascites Pancreatic carcinoma Arterial aneurism Splenic vein thrombosis
Complications - systemically
Diabetes
Steatorrhea
Chronic pain syndromes
Dependence on strong analgesics
Prognosis
Difficult to predict
Life expectancy reduced by 10-20 years
