Chronic Pancreatitis

Question 1

What are the causes of chronic pancreatitis?

Answer 1

Gallstones
Ethanol
Trauma/tumour
Steroids
Mumps
Autoimmune
S
Hyperlipidaemia/hypercalcaemia
ERCP
Drugs e.g. azothioprine

Question 2

What are the genetic causes of pancreatitis?

Answer 2

1. PRSS1 - AD
2. CF(TR) - AR
3. SPINK1
4. Pancreas divisum (parts of the pancreas don’t join together properly in utero)

Question 3

What are the acute complications of pancreatitis?

Answer 3

1. Systemic inflammatory response syndrome (like sepsis)
2. Respiratory failure and death

Question 4

What are the chronic complications of pancreatitis? (7)

Answer 4

1. Splenic and portal vein thrombosis
2. Psuedocysts
3. Biliary obstruction (resolve with stent by EUS)
4. Type 3 diabetes (high risk of hypos)
5. Duodenal stricture (resolve with stent)
6. Ductal stricture (painful)
7. Malignancy - difficult to differentiate on imaging

Question 5

How are psuedocysts managed?

Answer 5

Often resolve after 6 weeks but sometimes require drainage into the stomach by axios stent with EUS

Question 6

How is chronic pancreatitis managed?

Answer 6

1. MDT approach
2. Creon + PPI
3. Whipple’s resection
4. Pancreatectomy in rare cases