Chronic Pancreatitis Flashcards Preview

Gastrointestinal Conditions > Chronic Pancreatitis > Flashcards

Flashcards in Chronic Pancreatitis Deck (17):
1

What is acute pancreatitis?

Chronic inflammation of the pancreas, associated with severe abdominal pain and endocrine/exocrine dysfunction, resulting in irreversible damage

2

Sex preponderance of chronic pancreatitis

M>F (4:1)

3

Prevalence in UK of chronic pancreatitis

Rising

3/100,000

4

Pathophysiology of chronic pancreatitis:

Poorly understood

1. Reduced HCO3- leading to activation of pancreatic enzymes

2. Alcohol induced duct dilatation

3. Direct toxic effect of alcohol on pancreas

5

End pathological result of chronic pancreatitis:

Pancreatic fibrosis

6

Causes of chronic pancreatitis:

Alcohol
Smoking
Autoimmune
Metabolic (hypercalcaemia, hyperlipidaemia)
Iatrogenic (e.g. ERCP)
Drugs
Azathioprine
Sulphonamides
Loop diuretics
Familial
Cystic fibrosis
Haemochromatosis
Pancreatic duct obstruction
Congenital
Idiopathic

7

Pathological subtypes of chronic pancreatitis:

1. Large duct
Easily seen on imaging
M>F
Diffuse pancreatic calcification
Steatorrhoea common
Pancreatic enzymes do not reduce pain
Surgery usually required

2. Small duct
Imaging usually normal
F>M
No calcification
Steatorrhoea rare
Sx respond to pancreatic enzymes

8

Symptoms of chronic pancreatitis:

Abdominal pain
Severe epigastric
Radiating to back
Relieved by sitting forwards
Relieved by hot water bottles

N & V

Anorexia

Weight loss

Diarrhoea/Steatorrhoea

Brittle diabetes
Extreme episodes of hyper/hypoglycaemia

9

Signs of chronic pancreatitis:

Erythema ab igne's
Mottled dusky greyness of skin caused by long term hot water bottle application to reduce pain

Weight loss

Abdo tenderness

10

Differential diagnosis

Cholecystitis
Peptic ulcer disease
Hepatitis
AAA
Pyelonephritis
Acute pancreatitis
Atypical MI
Pneumonia

11

Investigations for chronic pancreatitis:

1. Bloods: FBC, U&E, LFTs, Ca, Amylase, glucose, HBa1c

2. Imaging: USS + CT, MRCP, AXR

3. Faecal elastase

12

A marker of pancreatic exocrine insufficiency which is reduced in chronic pancreatitis:

Faecal elastase

13

Management of chronic pancreatitis:

Lifestyle:

* No alcohol
* Low fat diet
* Quit smoking

Pharmacological:

* Analgesia (Paracetamol -> NSAIDs -> Opiates
* Lipase
* Fat soluble vitamins A,D,E,K
* Insulin

Surgical:

* ERCP/endoscopic lithotripsy/laser lithotripsy (stones)
* Pancreaticojejunostomy
* Pancreatic resection

14

Indication for pancreaticojejunostomy

Duct dilatation >6mm

15

Indications for surgical intervention in chronic pancreatitis:

Management of complications (e.g. pseudocyst)

Stones (ERCP/endoscopic lithotripsy/laser lithotripsy)

>6mm duct dilatation (pancreaticojejunostomy)

Refractory pain (pancreatic resection e.g. pancreaticodudenectomy or pancreatectomy)

16

Complications of chronic pancreatitis:

Pseudocyst
Diabetes
Biliary obstruction
Effusions
Arterial aneurysm
Splenic vein thrombosis
Gastric varices
Pancreatic carcinoma

17

Prognosis of chronic pancreatitis:

1/3 die in 10 years

Drinking alcohol is worse prognosis

Autoimmune has better prognosis