Chronic Pancreatitis

Question 1

Description: What is chronic pancreatitis?

Answer 1

• Chronic inflammation of the pancreas

Question 2

Aetiology/Risk factors: What are the causes of chronic pancreatitis? (6)

Answer 2

Causes:

• Alcohol
• Cystic Fibrosis
• Congenital anatomical abnormalities
• Heredity pancreatitis
• Hypercalcemia, hyperlipidaemia
• Diet

Question 3

Pathology: What genes are associated with chronic pancreatitis? (3)

Answer 3

• CFTR
• SPINK1
• PRSS1

Question 4

Pathology: Describe the pathology of chronic pancreatitis.

Answer 4

• Glandular atrophy and fibrosis of pancreatic parenchyma

- Calcification (look out for this when diagnosing)

Question 5

Symptoms: What are the symptoms of chronic pancreatitis?

Answer 5

• Early disease is asymptomatic
• Upper abdominal pain
• Weight loss
• Steatorrhea
• Diabetes
• Jaundice

Question 6

Signs: What are the signs of chronic pancreatitis?

Answer 6

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Question 7

Investigations: What investigations do we perform to diagnose chronic pancreatitis? (5)

Answer 7

• Abdominal x-ray (shows calcification of the pancreas)
• Ultrasound (shows pancreatic cysts and ducts)
• Endoscopic ultrasound
• CT scan (VERY SENSITIVIE)
• Amylase (raised) in ACUTE EXACERBATIONS

Question 8

Treatment: How do we treat chronic pancreatitis?

a) Pain control (5
(b) Exocrine and endocrine control (3)
(c) Surgery (5)

Answer 8

(a) Pain control:
- Avoid alcohol
- Pancreatic enzyme supplements
- Opiate analgesia
- Celiac plexus block
- Surgery

(b) Exocrine and endocrine control:
- Low fat diet
- Pancreatic enzyme supplements
- Insulin (for diabetes mellitus

(c) Surgery
Drainage:
- Pancreatic duct sphincteroplasty
- Puestow

Resection:

• Whipple’s procedure
• Frey’s procedure
• Spleen – preserving distal pancreatectomy

Question 9

Complications:

Answer 9

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Question 10

Extra:

Answer 10

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