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Flashcards in Chronic pancreatitis Deck (26):
1

What the main changes would you see in chronic pancreatitis?

fibrosis, destruction of exocrine tissue, and endocrine tissue eventually.

2

What is the main difference between acute and chronic pancreatitis?

Acute pancreatitis will have normal histological and functional findings eventually. Chronic pancreatitis is permanent

3

What do you see pathologically in chronic pancreatitis?

A patchy, focal disease with PMNs and fibrosis

4

What do you see pathologically in acute pancreatitis?

Diffuse PMN inflammatory response

5

What is the most common cause of chronic pancreatitis?

Alcohol abuse

6

What are other causes of chronic pancreatitis?

1. idiopatic
2. hereditary
3. CF
Autoimmune
Ductal obstruction
Tropical pancreatitis
Hyperparathyroidism

7

What types of patients get idiopathic pancreatitis?

1. Young females (age 19)
2. Older males (age 56)

8

How is hereditary pancreatitis inherited?

Autosomal dominant

9

What is the main risk with hereditary pancreatitis?

Pancreatic cancer. 40% develop pancreatic cancer by age 70.

10

What mutations are seen in hereditary pancreatitis?

Mutation preventing the inactivation of trypsin.
Excess of trypsin activity and pancreatitis
R117H mutation on chromosome 7

11

What is different about the pancreatitis in CF?

usually no painful attacks, only exocrine insufficiency. Failure to thrive and malabsorption

12

What kind of antibody is seen in autoimmune pancreatitis?

IgG4

13

How do you treat autoimmne pancreatitis?

Corticosteroid therapy

14

What does tropical pancreatitis look like?What is the cause?

Calcific pancreatitis. NOT SEEN in the US> thought to have something to do with protein malnutrition

15

How does chronic pancreatitis present?

Abdominal pain-->anorexia and weight loss
Pain brought on by eating and radiating to the back. Discrete attacks progressing to continuous pain.

OR, can present with no pain but only pancreatic exocrine or endocrine dysfunction

16

What are the exocrine functional losses in pancreatitis?

Lipase=steatorrhea
Trypsin loss=azotorrhea
Malabsorption of vitamins
Note that 90% of cells must be lost

17

What are the endocrine functional losses in pancreatitis?

insulin and glucagon no longer produced. Difficult to treat.

18

What is the best imaging test to first evaluate chronic pancreatitis?

CT scan

19

What can a CT scan tell you?

ductal abnormalities
pancreatic calcification
pseudocysts

20

what is the most sensitive imaging test in chronic pancreatitis?

Endoscopic ultrasound: earlier detection

21

Why should you not use ERCP?

It can cause acute pancreatitis

22

What are tests of pancreatic function?

Secretin fxn test measures output of pancreas. NOT OFTEN USED

23

What are the compications of chronic pancreatitis?

1. Chronic pain
2. Steatorrhea (fat malabsorption), malnutrition, weight loss
3. Diabetes mellitus
4. Pancreatic ascites or pleural effusion
5. Pseudocyst
6. Splenic vein thrombosis
7. Duodenal obstruction
8. Common bile duct obstruction

24

How do you treat chronic pancreatitis?

1. stop alcohol
2. analgesics
3. Exogenous pancreatic enzymes if needed
4. Insulin if diabetic
5. Direct nerve blocks
6. Oral pancreatic enzymes if needed

25

What can splenic vein thrombosis lead to?

Esophageal varices

26

Pancreatic pseudocysts

Wall of granulation tissue from liquefied pancreas. Seen in chronic pancreatitis. Requires drainage. No epithelial layer.