Chronic Pancreatitis

Question 1

What is chronic pancreatitis?

Answer 1

It is defined as a condition in which there is chronic inflammation of the pancreas, resulting in permanent damage

Question 2

What is the pathophysiology of chronic pancreatitis?

Answer 2

This inflammation is due to enzyme-mediated autodigestion, caused by hypersecretion or an accumulation of exocrine digestive enzymes – such as amylase and lipase

This leads to necrosis of pancreatic tissue

Question 3

What are the six risk factors of chronic pancreatitis?

Answer 3

Alcoholism

Pancreatic Cancer

Pancreas Divisum

Annular Pancreas

Cystic Fibrosis

Haemochromatosis

Question 4

What is the most common risk factor of chronic pancreatitis in adults?

Answer 4

Alcoholism

Question 5

What is the most common risk factor of chronic pancreatitis in children?

Answer 5

Cystic fibrosis

Question 6

What are the six clinical features of chronic pancreatitis?

Answer 6

Sudden, Severe Epigastric Pain

Back Pain Radiation

Abdominal Distension

Nausea & Vomiting

Appetite Reduction

Steatorrhoea

Question 7

Describe the epigastric pain associated with chronic pancreatitis

Answer 7

The pain is relieved by sitting forward

The pain is worsened following meal consumption, usually after 15 - 30 minutes

Question 8

How is steatorrhoea a clinical feature of chronic pancreatitis?

Answer 8

This is due to pancreatic insufficiency

Question 9

When does steatorrhoea tend to present in chronic pancreatitis?

Answer 9

It develops between 5 and 25 years after the onset of pain

Question 10

What additional feature is associated with chronic pancreatitis related to haemochromatosis?

Answer 10

A grey discolouration of the skin

Question 11

What are the five investigations used to diagnose chronic pancreatitis?

Answer 11

Blood Tests

Ultrasound Scan

CT Scan

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Faecal Elastase

Question 12

What two blood test results indicate chronic pancreatitis?

Answer 12

Increased Serum Lipase Levels > 3x Normal Level

Increased Serum Amylase Levels > 3x Normal Level

Question 13

What are the three features of chronic pancreatitis on ultrasound scans?

Answer 13

Hyperechogenicity

Pancreatic Pseudocysts

Pancreatic Pseudoaneurysms

Question 14

What is the gold standard investigation used to diagnose chronic pancreatitis?

Answer 14

CT Scan

Question 15

What are the three features of chronic pancreatitis on CT scans?

Answer 15

Pancreatic Calcification

Pancreatic Duct Dilatation

Pancreatic Pseudocysts

Question 16

What is ERCP?

Answer 16

It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum

In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken

Question 17

What is the feature of chronic pancreatitis on ERCP?

Answer 17

A ‘chain of lakes’ appearance of the main pancreatic duct

This indicates that duct has become dilated and tortuous

Question 18

When is faecal elastase used to investigate chronic pancreatitis?

Answer 18

When imaging scans are inconclusive

Question 19

What is the faecal elastase test?

Answer 19

It involve measuring the amount of the human pancreas specific enzyme, elastase, is contained within faeces

Question 20

How is the faecal elastase test used to investigate chronic pancreatitis?

Answer 20

It enables evaluation about the pancreas’s EXOCRINE function and therefore identification of pancreatic insufficiency, which is a complication of chronic pancreatitis

Question 21

What faecal elastase test result indicates chronic pancreatitis?

Answer 21

Decreased levels of faecal elastase

Question 22

What are the three conservative management options of chronic pancreatitis?

Answer 22

Alcohol Cessation

Smoking Cessation

Low Fat, High Protein Diet

Question 23

What are the two pharmacological management options of chronic pancreatitis?

Answer 23

Pancreatic Enzyme Supplementation

Analgesia

Question 24

Name a pancreatic enzyme supplement

Answer 24

Creon

Question 25

How are pancreatic enzyme supplements used to manage chronic pancreatitis?

Answer 25

They replace the pancreatic enzymes usually produced by the pancreas to aid digestion of food

This is required due to the chronic inflammation resulting in permanent damage to the pancreas, and therefore dysfunction of endocrine and exocrine function

Question 26

Name two analgesia drugs used to manage chronic pancreatitis

Answer 26

Codeine

Tramadol

Question 27

When is analgesia used to manage chronic pancreatitis?

Answer 27

It is used to manage chronic pancreatitis attacks

Question 28

What are the two surgical management options of chronic pancreatitis?

Answer 28

Partial Pancreatectomy

Total Pancreatotomy

Question 29

What is partial pancreatectomy?

Answer 29

It involves resection of the inflamed regions of the pancreas

Question 30

What is total pancreatectomy?

Answer 30

It involves resection of the whole pancreas, as well as the duodenum, common bile duct, gallbladder and spleen

Question 31

How is pancreatic function restored following total pancreatectomy?

Answer 31

Autologous pancreatic islet cell transplantation (APICT)

Question 32

What is APICT?

Answer 32

It involves removal of the islet cells, which are responsible for the production of insulin, prior to surgical removal of the pancreas

These cells are then mixed with a special solution and injected into the liver, which enables liver production of insulin

Question 33

What are the six complications associated with chronic pancreatitis?

Answer 33

Necrotising Pancreatitis

Pancreatic Insufficiency

Pancreatic Pseudocysts

Diabetes Mellitus

Portal Vein/Splenic Thrombosis

Malnutrition

Question 34

When does diabetes melltius tend to develop in chronic pancreatitis?

Answer 34

It develops > 20 years of symptom onset