Chronic Pancreatitis Flashcards
(8 cards)
Define
Chronic inflammatory disease of the pancreas characterised by irreversible parenchymal atrophy and fibrosis leading to impaired endocrine and exocrine function and recurrent abdominal pain
Aetiology/Risk factors
Alcohol (70%), Idiopathic in 20%
70% alcohol
Rare: Recurrent acute pancreatitis, ductal obstruction, pancreas divisum, hereditary pancreatitis, tropical pancreatitis, autoimmune pancreatitis, hyperparathyroidism, hypertiglycidaemia
Epidemiology
Mean age- 40-50 years in alcohol-associated disease
1/100000, Annual UK incidence
Symptoms
Recurrent severe epigastric pain, radiating to back, relieved by sitting forward, can be exacerbated by eating or drinking alcohol
- Over many years, weight loss, bloating and pale offensive stools (steatorrhoea)
Signs
Epigastric tenderness
- Signs of complications e.g. weight loss, malnutrition
Investigations
- Blood: Glucose (increase indicates endocrine dysfunction, glucose tolerance test. Raised immunoglobulins, especially IgG4 in autoimmune pancreatitis
- USS: percutaneous or endoscopic, can show hyperechoic foci with post-acoustic shadowing
- ERCP or MRCP: Early changes include main duct dilatation and stumping of branches. Late manifestations are duct strictures with alternating dilatation
- AXR: Pancreatic calcification may be visible
- CT: Pancreatic cysts, calcification
- Tests of pancreatic exocrine function: FAECAL ELASTASE
Management
General: Mainly symptomatic and supportive tx, e.g. dietary, abstinence from alcohol and smoking, treatment of diabetes, oral pancreatic enzyme replacements
- Endoscopic therapy: Sphincterotomy, stone extraction, dilatation or stenting of strictures
- Surgical: May be indicated if medical management has failed. Later pancreaticojejunal drainage, resection or limited resection of the pancreatic head
Complications
- Psuedocytsts
- Biliary duct stricture
- Duodenal obstruction
- Pancreatic ascites
- Pancreatic carcinoma
