Chronic Pancreatitis

Question 1

Definition of aetiology of chronic pancreatitis

Answer 1

Definition
Chronic inflammation , permanent, progressive, morphological or functional damage of pancreas

Aetiology
~ alcohol
~ obstruction of pancreatic duct
~ hyperparathyroidism
~ CFTR gene mutation : cystic fibrosis
decreases bicarbonate, promotes protein plugging
~ tropical pancreatitis: Africa and Asia
~ hereditary
~ Autoimmune
~ idiopathic

Question 2

Pathogenesis of chronic pancreatitis

Answer 2

Repeated attacks of acute pancreatitis—> chronic

1. Obstruction theory
   ~ increase protein- ductal plugs - calcification - calculi- obstruction of pancreatic ducts
2. Necrosis fibrosis theory.
   ~ inflammation- obstruction and stasis of ducts- stones
3. Toxic metabolite theory
   ~ direct toxic damage to acinar cells- necrosis - fibrosis
4. Oxidative stress theory.
   ~ generates free radicals- lipid peroxidation - recurrent inflammation, tissue damage, fibrosis

5.Profibrogenic chemokines
~ TGF beta, PDGF
~ activation and proliferation of periacinar myofibroblast (stellate) - deposit collagen- fibrosis

Question 3

Morphology of chronic pancreatitis

Answer 3

Gross:
1. non- obstructive chronic
~ most common
~ nodular, hard
~ cut section: dilated ducts, calcified concretions
~ when calcification is extrinsic- Chronic calcifying pancreatitis

2. Obstructive chronic pancreatitis
   ~ narrowing or occlusion of pancreatic ducts
   ~ due to carcinoma and stones

Micro:
~ Parenchymal fibrosis- periductal, intra lobular, inter lobular
~ atrophy of acini- reduction in size and number
~ dilation of pancreatic ducts + protein plus
~ alteration in ductal epithelium - atrophy/ hyperplasia/ squamous metaplasia
~ chronic inflammatory infiltrate- L,P, M

Question 4

Features of chronic pancreatitis

Answer 4

~ attacks of abdominal pain + back pain
~ silent until severe damage
~ pancreatic exocrine insufficiency: weight loss + hypoalbuminaemia edema
~ pancreatic endocrine insufficiency: diabetes mellitus
~ prognosis- poor

Question 5

Complications of chronic pancreatitis

Answer 5

~ pancreatic Pseudocysts
~ malabsorption, steatorrhea
~ secondary diabetes
~ risk of pancreatic cancer