Pancreatitis (Chronic)

Question 1

def

Answer 1

chronic inflammation of the pancreas characterised by irreversible parenchymal atrophy + fibrosis
impaired endocrine + exocrine function

Question 2

aetiology

Answer 2

1 alcohol (70%)
2 idiopathic (20%)

• -rare–
• recurrent acute pancreatitis
• ductal obstruction
• CF
• haemochromatosis
• hyperparathyroidism

Question 3

epi

Answer 3

incidence 1/100,000 PA in UK
prevalence 3/100,000
40-50yrs

Question 4

incidence vs prevalenec

Answer 4

incidence is how many get it per year

prevalence is how many people have it

Question 5

history

Answer 5

1 severe epigastric pain
2 weight loss over many years
3 pale offensive stools (steatorrhoea)

Question 6

what is the pain like in chronic pancreatitis

Answer 6

severe epigastric pain
radiates to back
relieved by sitting forward
exacerbated by eating/drinking + alcohol

Question 7

examination

Answer 7

1 epigastric tenderness
2 complications (weight loss)

Question 8

pathogenesis

Answer 8

1 disruption of pancreatic glandular architecture due to inflammation
2 pancreatic stellate cells convert fat storing cells to myofibroblast like cells which form ECM, cytokines + GFs in response to injury
3 pain is due to raised intraductal pressures + inflammation

Question 9

investigations

Answer 9

1 bloods
-high glucose may indicate endocrine dysfunction
-amylase + lipase usually normal in CP
2 USS + CT + AXR
-pancreatic calcification confirms diagnosis
3 MRCP + ERCP
-early changes: duct dilatation
-late changes: alternating duct strictures + dilatation

Question 10

management

Answer 10

1 general
-symptomatic + supportive treatment (pain relief, dietary advice, stop smoking/drinking, manage diabetes)
2 endoscopic therapy
-sphincterotomy
-stone extraction + extracorporeal shock-wave lithotripsy to break up large pancreatic stones
-stenting strictures
3 surgery
-pancreatectomy
-pancreaticojejunostomy (duct drainage)

Question 11

what is whipples procedure

Answer 11

pancreatoduodenectomy

operation to remove part of the pancreas, part of the small intestine and the gallbladder

Question 12

what is resection of the pancreas head called

Answer 12

beger procedure

Question 13

complications

Answer 13

1 local
-pseudocyst
-biliary obstruction
-pancreatic carcinoma
2 systemic
-diabetes

Question 14

prognosis

Answer 14

surgery improves symptoms but this is often not sustained

10-20yr life expectancy reduction