Chronic Pancreatitis

Question 1

What is it?

Answer 1

Chronic inflammation of the Pancreas caused by increased levels of activated Trypsin

Question 2

What causes trypsin levels to rise?

Answer 2

Due to premature trypsinogen clearance or impaired clearance of trypsin. Often caused by alcohol related activation or trypsin

Question 3

Why do people get it? (2)

Answer 3

Alcohol-related or Genetic (PRSS1, SPINK-1, Mutated calcium receptor)
Autoimmune related to IgG4 autoantibodies (type 1 and type 2)

Question 4

Who is affected?

Answer 4

Normally middle aged men, 60-80% caused by alcohol

Question 5

Risk Factors (6)

Answer 5

Alcohol, Hereditary, Cystic Fibrosis, Trauma, Tropical disease, Hypercalcaemia

Question 6

Symptoms (6)

Answer 6

Epigastric pain radiating to the back, episodic, exacerbation following alcohol, weight loss, anorexia, steatorrhoea

Question 7

Signs (2)

Answer 7

Pancreatic insufficiency, jaundice (due to common bile duct obstruction)

Question 8

Investigations (7)

Answer 8

Serum Amylase and Lipase, Faecal Elastase, Endoscopic Ultrasound, CT, MRCP, Gene Analysis

Question 9

Main Differential

Answer 9

Malignancy

Question 10

Treatment (5)

Answer 10

Alcohol abstinence, Pain relief, Pancreatic duct drainage, Lithotripsy to fragment calcifications in the Pancreas Head, replacement of insufficiency (e.g digestive enzymes and insulin)

Question 11

Complications (6)

Answer 11

Pseudocysts, Bleeding, Pancreatic Rupture, Ascites, Malignancy, Pancreatic Failure