Chronic pancreatitis Flashcards
1
Q
Define chronic pancreatitis
A
- chronic fibro-inflammatory disease of pancreas resulting in progressive and irreversible damage to pancreatic parenchyma
2
Q
What are the unmodifiable RF for chronic pancreatitis?
A
- Male
- Age - >40
3
Q
What causes chronic pancreatitis?
A
- Alcohol abuse (60%)
- Idiopathic (30%)
- Hyperliidaemia, hyprcalcaemia
- HIV, mumps, Echinoccus
- CF, SLE
- Pancreas Divisum
4
Q
What are the clinical features of chronic pancreatitis?
A
- acute on chronic pain - epigastric pain radiate to back
- N&V
- Endocrine insufficiency
- impair glucose regulation
- Exocrine insufficinecy
- weight loss, diarrhoea, steatorrhea,
- Tender in epigastrium
- cachexia
- malabsoprtion
5
Q
What is Type 3c (pancreatogenic) diabetes?
A
- Diabetes mellitus secondary to pancreatic disease resulting in endocrine dysfunction
6
Q
What are the differential diagnosis for chronic pancreatitis?
A
- PUD
- GORD
- AAA
- Biliary colic
- Chronic mesenteric ischamia
7
Q
What Ix would you order for chronic pancreatitis?
A
- Routine bloods
- Urine dip
- Serum amylase & lipase ; normal
- magnesium, haemoglobin, albumin, prealbumin and retinol binding protein (low)
- Blood glucose (high)
- LFT
- Faecal elastase: low
-
CT imaging - diagnostic test
- pancreatic atrophy, calcification, ductal dilatation
- Secretin simulation test
- MRCP
- EUS
- Pancreatic biopsy
8
Q
How would you Mx chronic pancreatitis?
A
- Conservative
- Alcohol cessation
- Statin therapy
- analegesia (avoid opioids - lead to gastroparesis)
- enzyme replacement (Creon)
- Octreotide
- vitamin supplementation
- Insulin
- Steroids
- ERCP
- Stone removal
- stent placement
- sphincterotomy
- Endosonography-guided celiac plexus blockade
- Pancreatic resection
- Beger’s procedure
- Frey’s procedure
- radical surgery
9
Q
Why surgical intervention rarely performed for chronic pancreatitis?
A
- high morbidity and mortality
- limited symptomatic improvement
10
Q
What is Berger’s procedure?
A
- resection of the pancreatic head
- duodenal preserving
11
Q
What is Frey’s procedure?
A
- extended lateral pancreaticojejunostomy
