Chronic pancreatitis Flashcards
Define chronic pancreatitis
Chronic inflammatory disease of the pancreas characterised by irreversible parenchymal atrophy & fibrosis leading to impaired endocrine & exocrine function & recurrent abdominal pain
Aetiology of chronic pancreatitis
2 causes + 2
ALCOHOL - 70%
Idiopathic - 20%
Caused by disruption of normal pancreatic glandular architecture due to chronic inflammation & fibrosis, calcification, parenchymal atrophy, ductal dilation & cyst & stone formation
Pain associated w/ raised intraductal pressures
Epidemiology of chronic pancreatitis
prev/inc, age
Prevalence 3/100,000, annual UK incidence 1/100,000
Mean age 40-50 yrs (in alcohol-associated disease)
Rare causes of chronic pancreatitis
7
Recurrent acute pancreatitis Ductal obstruction Pancreas divisum Hereditary pancreatitis Tropical pancreatitis Autoimmune pancreatitis Hyperparathyroidism
Presenting symptoms of chronic pancreatitis
5
Recurrent severe epigastric pain
Pain radiates to back
Pain relieved by sitting forward
Pain can be aggravated by eating or drinking alcohol
Weight loss, bloating, steatorrhoea (over many years)
Signs of chronic pancreatitis on physical examination
2
Epigastric tenderness
Signs of complications - weight loss, malnutrition
Investigations for chronic pancreatitis
6
Bloods US ERCP/MRCP AXR CT Pancreatic exocrine function
Investigations for chronic pancreatitis - bloods
3
High glucose - glucose tolerance test
Amylase & lipase - usually normal
High Ig
Investigations for chronic pancreatitis - ERCP/MRCP
2 early, 1 late
Early changes - main duct dilatation & stumping of branches
Late manifestations - duct strictures w/ alternating dilatation
Investigations for chronic pancreatitis - AXR
May show pancreatic calcification
Investigations for chronic pancreatitis - CT
May show pancreatic calcification & cysts
Investigations for chronic pancreatitis - pancreatic exocrine function
Faecal elastase
Management of chronic pancreatitis
3
General
Endoscopy therapy
Surgical
Management of chronic pancreatitis - general
2
Treatment mainly symptomatic & supportive
Chronic pain management may need specialist input
Management of chronic pancreatitis - endoscopy therapy
4
Sphincterotomy
Stone extraction
Dilatation & stenting of structures
Extracorporial shock wave lithotripsy - sometime sured to fragment larger pancreatic stones before removal
Management of chronic pancreatitis - surgical
5
May be indicated if medical management fails
Lateral pancreaticojejunal drainage - modified Puestow procedure
Pancreatic resection - pancreaticoduodenectomy or Whipple’s procedure
Limited resection of pancreatic head - Beger procedure
Combining opening of pancreatic duct & excavation of pancreatic head - Frey procedure
Complications of chronic pancreatitis
2
Local
Systemic
Complications of chronic pancreatitis - local
5
Pseudocysts Biliary duct stricture Duodenal obstruction Pancreatic ascites Pancreatic carcinoma
Complications of chronic pancreatitis - systemic
4
Diabetes
Steatorrhoea
Chronic pain syndromes
Dependence on strong analgesics
Prognosis of chronic pancreatitis
3
Difficult to predict
Surgery improves symptoms in 60-70% but results often not sustained
Life expectancy may be reduced by 10-20 yrs
