chronic pancreatitis Flashcards
definition of chronic pancreatitis?
- chronic inflammatory disease of the pancreas characterized by irreversible and parenchymal atrophy and fibrosis leading to impaired endocrine and exocrine function
and recurrent abdominal pain
what are the main causes of chronic pancreatitis?
I GET SMASHED
main causes = alcohol
what is the epidemiology of chronic pancreatitis?
- 1/100 000 in the UK
- mean age is 40-50 in alcohol-associated disease
what is the common presenting history of chronic pancreatitis?
- recurrent severe epigastric pain radiates to the back
- pain relieved by sitting forwards
- made worse by eating and drinking
- overtime = weight loss, bloating, and steatorrhoea
what will an examination of chronic pancreatitis show?
- epigastric tenderness
- observation might show weight loss and malnutrition
what is the pathogenesis of chronic pancreatitis?
- disruption of normal pancreatic structure due to chronic inflammation and fibrosis, calcification, atrophy, ductal dilation and stone formation
- pancreatic stellate cells convert fat storing cells to myofibroblast like cells to form an extracellular matrix
- cytokines respond to the injury
- pain occurs due to raised intraductal pressures and inflammation
what bloods need to be taken for chronic pancreatitis?
- glucose (will be raised due to endocrine dysfunction)
- amylase and lipase may be normal
- increase in immunoglobulins (IgG4 in autoimmune causes)
why might an ultrasound scan be taken?
- may show hyperchoic foci (bright spots)
what might an ERCP or MRCP show?
- may show main duct dilation
- stumping of branches
what will an abdominal x- ray show?
- pancreatic calcification
what might a CT scan show?
- pancreatic cysts, calcification
what does faecal elastase stool test show?
- shows pancreatic exocrine insufficiency
- no elastase is ABNORMAL
what is the general management of chronic pancreatitis?
- symptomatic and supportive
- examples including:
dietry advice
no alcohol
treatment of diabetes
pancreatic enzyme replacement
analgesia
what endoscopic treatment can be used for chronic pancreatitis?
- sphincterotomy
- stone extraction
- dilation or stenting of strictures
- extracorporeal shock wave therapy can destro the stones
what surgical treatment can be used for chronic pancreatitis?
- this may be indicated if medical management has failed
- lateral pancreaticojejunal drainage
- full resection (whipples)
- limited resection (beger)
- opening of the pancreatic duct and excavation of the pancreatic head ( frey procedure)
