Chronic Pancreatitis Flashcards
What is chronic pancreatitis?
Irreversible pancreatic parenchymal atrophy + fibrosis leading to impaired endocrine + exocrine function + recurrent abdominal pain.
Explain the aetiology of chronic pancreatitis
Disruption of normal pancreatic glandular architecture due to chronic inflammation + fibrosis, calcification, parenchymal atrophy, ductal dilation + cyst + stone formation
Pain is associated with raised intraductal pressures
What are the 2 main causes of chronic pancreatitis?
ALCOHOL: 70%
Idiopathic: 20%
Summarise the epidemiology of chronic pancreatitis
Annual UK incidence: 1/100,000
Mean age: 40-50 yrs (in alcohol-associated disease)
Describe the pain in chronic pancreatitis
Recurrent severe epigastric pain
Radiates to the back
Relieved by sitting forward
Aggravated by eating or drinking alcohol
Over many years –> weight loss, bloating + steatorrhoea
Give 2 signs of pancreatitis on physical examination
Epigastric tenderness
Signs of complications e.g. weight loss, malnutrition
What bloods results are seen in chronic pancreatitis?
High glucose (endocrine dysfunction): glucose tolerance test may be performed Amylase + lipase usually normal High Ig (especially IgG4 in AI)
Other than bloods, what investigations are performed for chronic pancreatitis?
CT/ MRI: pancreatic calcification + cysts
Endoscopic US
MRCP:
Early: main duct dilatation + stumping of branches
Late: duct strictures with alternating dilatation
AXR: pancreatic calcification
Faecal elastase (exocrine function) LOW
List 7 rare causes of chronic pancreatitis
Recurrent acute pancreatitis Ductal obstruction: strictures- trauma, stones Pancreas divisum Hereditary pancreatitis Tropical pancreatitis AI pancreatitis Systemic: CF, Hyperparathyroidism
Describe the medical management of chronic Pancreatitis
Symptomatic + supportive: Dietary advice Stop smoking/drinking Treat diabetes Oral pancreatic enzyme replacement Analgesia
What endoscopic therapy can be used in chronic pancreatitis?
Sphincterotomy
Stone extraction
Dilatation + stenting of strictures
Extracorporial shock-wave lithotripsy sometimes used to fragment large stones before removal
When and what surgical methods are used in chronic pancreatitis?
If medical tx fails/ Ca suspected
Pancreaticojejunostomy
Pancreatic resection (Whipple’s)
What 5 local complications may arise from chronic pancreatitis?
Pseudocysts Biliary duct stricture Duodenal obstruction Pancreatic ascites Pancreatic carcinoma
What 4 systemic complications may arise from chronic pancreatitis?
Diabetes
Steatorrhoea
Chronic pain syndromes
Dependence on strong analgesics
What is the prognosis for patients with chronic pancreatitis?
Surgery improves Sx in 60-70% but results often not sustained
Life expectancy may be reduced by 10-20 years
