Chronic Pancreatitis

Question 1

Causes (AGITS)

Answer 1

Alcohol

Genetic:

• Cystic fibrosis
• Haemochromatosis

Immune

• type 1 - raised IgG4
• type 2 - 30% associated with inflammatory bowel disease

Triglycerides - increased

Structural:

• Tumour - obstruction
• Gall stones obstruction

Question 2

Presentation

Answer 2

Epigastric pain radiating to back 
Pain worse after meal 
Episodic or chronic 
Anorexia 
Nausea and vomiting 
Polydipsia 
Polyuria 
Jaundice due to obstruction of the common bile duct 
- pale, floating, foul smelling stools - steatorrhoea
- dark urine
DM - after 20 years

Question 3

Investigations

Answer 3

Abdominal examination 
Obs 
Bloods - FBC, U+Es, LFTs, HbA1c, serum lipase, serum IgG4
Faecal elastase 
VBG - oxygen 
USS - psuedocyst
CT - if USS suggestive 
MRCP - if CT inconclusive
AXR - calcified pancreas

Question 4

Triad

Answer 4

Epigastric pain
Diabetes
Steatorrhoea

Question 5

Management

Answer 5

Conservative:

• smoking cessation
• alcohol cessation
• diet modification - low fat with high carb

Medical:

• analgesia
• enzyme supplements - creon
• vitamins ADEK
• DM control

Surgery: pancreatectomy

Question 6

Complications

Answer 6

Malabsorption 
Diabetes mellitus 
Pseudocysts 
Pancreatic carcinoma
Biliary obstruction