Chronic pancreatitis

Question 1

What is chronic pancreatitis?

Answer 1

Ongoing inflammation of pancreas, irreversible destruction of endocrine and exocrine function

Question 2

What are cause of chronic pancreatitis

Answer 2

Repeated attacks of acute
Alcohol
Idiopathic
mumps, CF, autoimmune
Pancreas divisum 
Hypercalcaemia

Question 3

What are Sx of chronic pancreatitis?

Answer 3

Chronic epigastric pain radiating to back, relieved by sitting forward
N+V
Weight loss + steatorrhoea
DM

Question 4

What are risk factors for chronic pancreatitis

Answer 4

alcohol
smoking 
FH
coeliac 
autoimmune (PBC, PSC)

Question 5

What Ix in chronic pancreatitis?

Answer 5

Abdo CT: calcification, enlarged pancreas, duct dilation

Abdo US: duct dilation.

AXR: calcification.

ERCP/MRCP can show beading of pancreatic duct due to dilation and stenosis

Bloods show high glucose. Amylase/lipase normal.

Faecal elastase is low, fat is increased.

Question 6

What are DDx for chronic pancreatitis?

Answer 6

Pancreatic cancer
Acute pancreatitis
Biliary colic 
PUD
Mesenteric ishcaemia

Question 7

What is Rx of chronic pancreatitis?

Answer 7

lifestyle

Analgesia: paracetamol, ocreotide is good
Creon to replace enzymes
Insulin if needed
Fat soluble vitamins

Surgery due to Sx. duct decompression (can be endoscopic)
ESWL for calcification
Whipple if head affected
Distal pancreatectomy if tail affected

Question 8

What are complications of chronic pancreatitis>

Answer 8

Chronic pain
DM
Pseudocyst
Obstruction in ducts