Chronic Pancreatitis

Question 1

Clinical features of Chronic pancreatitis.

Answer 1

Epigastric pain that bores through the back.

This pain is relieved by sitting forward or hot water bottles on epigastrium and the back.

There might be bloating, steatorrhoea, brittle diabetes and weight loss.

Question 2

Causes of chronic pancreatitis.

Answer 2

Alcohol

Smoking

Autoimmune

CF

Haemochromatosis

Pancreatic duct obstruction due to stones or tumours

Congenital

Question 3

Investigations of chronic pancreatitis.

Answer 3

Ultrasound and CT - you will find pancreatic calcifications to confirm the diagnosis.

MRCP and AXR can be done as well - will show speckled calcifications and faecal elastase.

Bloods - CRP, ESR, FBC, LFTs, Amylase

Question 4

Pharmacological treatment of chronic pancreatitis.

Answer 4

Give analgesia

Lipase

Fat-soluble vitamins

Insulin might be needed

Question 5

Dietary treatment of chronic pancreatitis.

Answer 5

No alcohol

Low fat may help

Medium chain triglycerides might help.

Question 6

Surgery for chronic pancreatitis.

Answer 6

If there is unremitting pain, loss of weight or narcotic abuse.

Pancreatectomy or pancreaticjejunostomy might be performed

Question 7

Complications of chronic pancreatitis.

Answer 7

Pseudocysts

Diabetes

Biliary obstruction

Local arterial aneurysm

Splenic vein thrombosis

Gastric varices

Pancreatic carcinoma