Pancreatitis - Chronic

Question 1

Define Chronic Pancreatitis

Answer 1

Inflammation of the pancreas characterised by recurrent or persistent abdominal pain + progressive injury to the pancreas and surrounding structures -> scarring + loss of function

Question 2

What are the hallmark features of chronic pancreatitis

Answer 2

Reduced pancreatic exocrine function
Malabsorption
Diabetes
Pancreatic calcifications

Question 3

Aetiology of Chronic Pancreatitis

Answer 3

Hereditary
Juvenile idiopathic
Alcoholic
Senile idiopathic

Question 4

Symptoms of Chronic pancreatitis

Answer 4

Asymptomatic for years

Epigastric pain (Bores to the back | relieved by sitting forward or hot water bottles | dull | worse 30 mins post-prandially | short episodes (relapsing) or constant (type B)
Bloating 
Foul-smelling steatorrhoea 
Weight loss
DM: polyuria, polydipsia
Nausea and vomiting
Painful joint 
SOB

Question 5

Signs for chronic pancreatitis

Answer 5

Erythema ab igne (mottled dusk greyness)
epigastric tenderness
Jaundice
Skin nodules -> fat necrosis
Abdominal distension

Question 6

Investigations for Chronic Pancreatitis

Answer 6

CT: pancreatic calcifications (focal or diffuse enlargement of the pancreas, ductal dilation vascular complication, atrophy)

Blood glucose: may be elevated due to DM

USS: Structural/anatomical changes and calcifications
AXR: pancreatic calcifications
MRCP: info on pancreas and ducts

Question 7

Management for Chronic Pancreatitis

Answer 7

Alcohol and smoking cessation
Low fat diet
Medium chain tricglycerides

Analgesia 
Pancreatic enzyme supplement - Creon 
Fat soluble vitamins (ADEK)
Insulin diabetes and diabetes
Antioxidants

Unremitting pain, narcotic abuse, weight loss -> pancreatectomy or pancreatojejunostoomy

Question 8

Complications of Chronic Pancreatitis

Answer 8

Pancreatic exocrine insufficiency 
Diabete Mellitus 
Pancreatic calcifications or duct obstruction
Biliary obstruciton
Low-tramuma fracture 
Gastroduodenal obstruction
Pancreatic cancer/carcinoma 
Opioid addiction
Fistula
Ascites e.g.

Question 9

Prognosis for Chronic Pancreatitis

Answer 9

Pan decreases or disappears over time, regardless of the aetiology. Around 70% of cases.
Pain relief correlates with development