Chronic pancreatitis

Question 1

What is the definition of chronic pancreatitis?

Answer 1

Progressive irreversible inflammatory disease of the pancreas

Question 2

What is the prevalence of chronic pancreatitis?

Answer 2

Prevalence of chronic pancreatitis is 40-70/100,000 population

Question 3

What is the pathology of chronic pancreatitis?

Answer 3

• Increased activated trypsin – due to premature activation or impaired clearance
• Leads to precipitation of proteins = plugs
• Obstruction = further pancreatic damage
• Can be due to mutation in genes responsible for Ca receptors
• Chronic alcohol intake ↑ levels of trypsinogen

Question 4

What are the risk factors/aetiology of chronic pancreatitis?

Answer 4

• Alcohol – most common cause
• CF
• Chronic kidney disease
• Haemochromatosis
• Idiopathic
• Trauma
• Hypercalcaemia
• Pancreatic duct obstruction
• Congenital – autosomal dominant
• Autoimmune – Type 1 (raised IgG4) and type 2

Question 5

What are the signs and symptoms of chronic pancreatitis?

Answer 5

• Episodic epigastric pain which radiates to the back – relieved by sitting forward/hot water bottle, made worse by alcohol consumption
• Bloating
• Diabetes
• Jaundice – due to obstruction of the common bile duct
• Steatorrhea
• Weight loss

Question 6

What other diseases can chronic pancreatitis present similarly to?

Answer 6

• Cholecystitis – inflammation of the gallbladder
• Cholangitis – inflammation of the bile duct
• Hepatitis
• Pancreatic malignancy
• Pancreatic pseudocysts

Question 7

What investigations are conducted when chronic pancreatitis is suspected?

Answer 7

• Bloods – serum amylase, serum lipase, serum IgG4
• Faecal elastase
• Gene mutation analysis
• Transabdominal US - gallstones
• Contrast enhanced CT – routinely performed 72h after attack
• MRCP/ERCP
• AXR

Question 8

What are the surgical treatments for chronic pancreatitis?

Answer 8

• Pancreatectomy

* Pancreaticojejuostomy – duct drainage procedure

Question 9

What are the pharmacological treatments for chronic pancreatitis?

Answer 9

• Analgesia
• Lipase
• Fat soluble vitamins
• Insulin – if sugars high
• CF treatment – if appropriate
• H2 receptor antagonists/PPI

Question 10

What are the non- pharmacological treatments for chronic pancreatitis?

Answer 10

• Avoid alcohol

* Low fat diet