Pancreatitis Flashcards
What are the causes of chronic pancreatitis?
Long term alcohol use of more than 150g per day for more than five years
Conditions such as pancreas divisum, inflammatory strictures and tumours which block the pancreatic duct
Hereditary pancreatitis where there is a defect in the trypsinogen gene
Autoimmune pancreatitis
Tropical calculous pancreatitis related to malnutrition
Describe some of the theories around the initiation and perpetuation of the chronic inflammation and fibrosis that occurs in chronic pancreatitis?
Diet rich in lipid increases protein secretion by the pancreas leading to precipitation of proteins in the pancreatic duct resulting in partial obstruction which when associated with toxic metabolites from alcohol initiates the process
Chromic pancreatitis may also be the result of recurrent bouts of acute pancreatitis
Oxidative stress is also thought to contribute to the disease process
Describe the pathophysiology of chronic pancreatitis
Pancreatic ducts are dilated with protein plugs which may be calcified and this leads to atrophy of the acinar cells and sometimes also the islets of langerhans. Increased pancreatic juice proteins and increased duct pressure precipitates the formation of protein plugs
The lack of lipases reaching the duodenum in advanced disease leads to fat malabsorption, fat soluble vitamin malabsorption and steatorrhea.
Diabetes mellitus can also occur
What are the risk factors for chronic pancreatitis?
Alcohol consumption
Smoking
Family history of chronic pancreatitis
Personal history of coeliac disease
What investigative tests would be done in chronic pancreatitis was suspected?
Glucose serum tests may show elevated glucose levels as glucose intolerance can occur early in the disease
Ct scan shows pancreatic calcifications, diffuse or focal enlargement of the pancreas, ductal dilation, vascular complications
Ultrasound and x ray will also show this but are not as sensitive
How is chronic pancreatitis managed?
Analgesia - paracetamol, ibuprofen, opiates
Pancreatic enzyme supplements (lipase)
Oral hypoglycaemic medications or insulin
Alcohol and smoking cessation
Low fat diet
Diet rich in antioxidants
Describe the pathogenesis of acute pancratitis
This is not well known but involves a pancreatic insult which results in activation of inactive enzyme precursors and leads to activation of inflammatory cytokines
What are the common causes of acute pancreatitis?
Gallstones Alcohol use Infections Tumours Drugs - azathioprine, furosemides, oestrogens, opiates Hyperlipidaemia Hypercalcaemia Genetic causes Pancreatic duct obstuction
What are the symptoms of acute pancreatitis?
Sudden onset abdominal pain Nausea Vomiting Fever Hypotension Shock Multi organ failure
What are some of the biochemical features of acute pancreatitis?
Raised amylase, lipase and urea
Decreased albumin, calcium and triglyceride
How much acinar tissue is generally lost in chronic pancreatitis before symptoms occur?
90%
