Chronic Pancreatitis Flashcards
Definition of Chronic Pancreatitis
A chronic inflammatory disease of the pancreas characterized by recurrent/permanent abdominal pain and fibrotic scarring of the pancreas (leading to loss of exocrine and endocrine function)
Explain the risk factors of Chronic Pancreatitis
- Chronic alcohol consumption (MAJOR RISK FACTOR - 70% to 80%)
- Cystic fibrosis
- haemochromatosis
- Sjögren’s syndrome
Explain the aetiology of Chronic Pancreatitis
- Chronic pancreatitis is caused by disruption of normal pancreatic glandular architecture due to:
- chronic inflammation
- fibrosis
- calcification
- parenchymal atrophy
- ductal dilation
- cyst formation
- Pancreatic stellate cells are thought to play a role, converting from quiescent fat-storing cells to myofibroblast-like cells that produce ECM and cytokines in response to injury.
Summarise the epidemiology of Chronic Pancreatitis
- The prevalence of chronic pancreatitis ranges from 0.04% to 5%
- The overall incidence ranges from 2 - 14 cases per year per 100,000 people
- Mean age: 40-50 yrs (in alcohol-associated disease)
Recognise the presenting symptoms of Chronic Pancreatitis
- (recurrent) DULL epigastric pain radiating to the back that is alleviated by sitting forwards but worsens post-prandially (MAY NOT BE PRESENT)
- Nausea & Vomiting (obstruction of bile duct/duodenum)
- Anorexia
Recognise the signs on physical examination
- Epigastric tenderness
- Abdominal distension (enlarged/ruptured pseudocysts, ruptured duct)
- Jaundice
- Steatorrhea (loose, greasy, foul-smelling stools that are difficult to flush away)
- Malnutrition (vitamin A,D,EK deficiencies)
- Diabetes Mellitus & hyperglycemia
Identify appropriate investigations for Chronic pancreatitis and interpret the results
-
Abdo contrast CT is the first line:
- shows calcifications, focal/diffuse enlargement, ductal dilation, cavities
- Blood Glucose (high glucose)
- Faecal elastase: low as it produced by pancrease
Generate a management plan for chronic pancreatitis
- Lifestyle changes (reduce alcohol and smoking) Analgesia (paracetamol/NSAIDs)
- Pancreatic enzyme replacement therapy e.g Pancreatin
- Insulin injections (be wary as this will induce hypoglycemia due to lack of glucagon)
- Have small frequent meals
SURGICAL OPTIONS (if all fails and pain persists):
- Pseudocyst decompression
- Pancreatic head resection
- Pancreatic duct/bile duct decompression
Complications of Chronic Pancreatitis (9)
- Pancreatic Exocrine Insufficiency (due to injury, atrophy, and loss of pancreatic exocrine tissue - managed with pancreatic enzyme replacement)
- Diabetes Mellitus
- Pancreatic calcifications
- Pancreatic duct obstruction (treat w/ decompression)
- Pancreatic ascites
- Opioid addiction due to chronic pain
- Pancreatic Cancer
- Obstructive cholestasis (caused by pancreatic head fibrosis)
- Pancreatic pseudocyst, which may become infected (a cystic lesion that may appear as a cyst on scans, but lacks epithelial or endothelial cells, instead surrounded by fibrous tissue)
Summarise the prognosis for patients with chronic pancreatitis
- Generally, pain decreases or disappears over time, regardless of aetiology - may vary from patient to patient, does not always decrease over time, and can be unpredictable.
- Ten-year survival after diagnosis is 20% to 30% lower than the general population
- Median life expectancy varies with aetiology
